Critical illness myopathy precedes hyperglycaemia and high glucose variability

J Crit Care. 2021 Jun;63:32-39. doi: 10.1016/j.jcrc.2021.01.012. Epub 2021 Jan 29.

Abstract

Background: Critical Illness Myopathy (CIM) is a serious ICU complication, and dysglycaemia is widely regarded as a risk factor. Although glucose variability (GV) has been independently linked to ICU mortality, an association with CIM has not been investigated. This study examines the relationship between CIM and GV.

Methods: Retrospective investigation including ICU patients with SOFA ≥8, mechanical ventilation, and CIM diagnostics. Glucose readings were collected every 6 h throughout the first week of treatment, when CIM is thought to develop. GV was measured using standard deviation (SD), coefficient of variability (CV), mean absolute glucose (MAG), mean amplitude of glycaemic excursions (MAGE), and mean of daily difference (MODD).

Results: 74 patients were included, and 50 (67.6%) developed CIM. Time on glycaemic target (70-179 mg/dL), caloric and insulin intakes, mean, maximum and minimum blood glucose values were similar for all patients until the 5th day, after which CIM patients exhibited higher mean and maximum glucose levels. Significantly higher GV in CIM patients were observed on day 5 (SD, CV, MAG, MAGE), day 6 (MODD), and day 7 (SD, CV, MAG).

Conclusions: CIM patients developed transient increases in GV and hyperglycaemia only late in the first week, suggesting that myopathy precedes dysglycaemia.

Keywords: Critical illness myopathy; Glucose; Insulin; Intensive care unit; Intensive care unit acquired weakness; Variability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Glucose
  • Critical Illness
  • Humans
  • Hyperglycemia*
  • Hypoglycemic Agents
  • Muscular Diseases* / etiology
  • Retrospective Studies

Substances

  • Blood Glucose
  • Hypoglycemic Agents