Optimal blood glucose targets for critically ill patients with sepsis in the intensive care unit

BackgroundHyperglycemia and hypoglycemia are key risk factors for morbidity and mortality in critically ill septic patients. Despite ongoing research, glucose management guidelines for critically ill patients remain inconsistent, especially for diabetic patients. This study identifies optimal glucose targets to reduce mortality in critically ill patients with sepsis. Research QuestionWhat is the optimal blood glucose range associated with reduced in-hospital mortality for critically ill patients with sepsis, and how does this vary by diabetic status? Study Design and MethodsThis cohort study analyzed 22,374 adult intensive care unit (ICU) patients with sepsis from the MIMIC-IV database. Non-linear logistic regression models assessed the relationship between 72-hour median blood glucose levels and in-hospital mortality, adjusting for age, gender, and Sequential Organ Failure Assessment (SOFA) score. Subgroup analyses explored variations based on diabetic status and other clinical factors. ResultsThe study found a U-shaped relationship between blood glucose levels and mortality, with the lowest risk at 6.3 mmol/L overall and 6.8 mmol/L for diabetic patients. A 5-8 mmol/L glucose range during the first 72 hours was associated with a mortality risk below 10%, representing up to a 5% reduction in mortality compared to the guideline targets of 7.8-10.0 mmol/L. No significant differences were found between patients with or without skin and soft tissue infection. InterpretationThe findings suggest that a tighter glycemic control range of 5-8 mmol/L could improve survival in ICU patients with sepsis, challenging current guidelines. Further randomized controlled trials are necessary to validate and optimize glycemic control strategies for critically ill septic patients. Clinical Trial RegistrationNot applicable. Take-Home PointsO_ST_ABSStudy QuestionC_ST_ABSWhat is the optimal blood glucose level for reducing mortality in critically ill patients with sepsis? ResultsA U-shaped relationship was found, with the lowest mortality risk at 6.3 mmol/L overall and 6.8 mmol/L for people with diabetes. Patients with a 5-8 mmol/L glycemic range had an approximate 50% reduced mortality risk compared to those who maintained glycemic ranges within existing guideline recommendations. InterpretationUnlike the guideline-recommended glucose targets of 7.8 - 10mmol/L, a tighter glycemic target (5-8 mmol/L) may improve mortality for critically ill patients with sepsis.