Accuracy of different methods for blood glucose measurement in critically ill patients
Keywords:
Hyperglycemia, Hypoglycemia, Sepsis, Norepinephrine, Shock, septicAbstract
CONTEXT AND OBJECTIVE: Although glucometers have not been validated for intensive care units, they are regularly used. The aim of this study was to compare and assess the accuracy and clinical agreement of arterial glucose concentration obtained using colorimetry (Agluc-lab), capillary (Cgluc-strip) and arterial (Agluc-strip) glucose concentration obtained using glucometry and central venous glucose concentration obtained using colorimetry (Vgluc-lab). DESIGN AND SETTING: Cross-sectional study in a university hospital. METHOD: Forty patients with septic shock and stable individuals without infection were included. The correlations between measurements were assessed both in the full sample and in subgroups using noradrenalin and presenting signs of tissue hypoperfusion. RESULTS: Cgluc-strip showed the poorest correlation (r = 0.8289) and agreement (-9.87 ± 31.76). It exceeded the limits of acceptable variation of the Clinical and Laboratory Standards Institute in 23.7% of the cases, and was higher than Agluc-lab in 90% of the measurements. Agluc-strip showed the best correlation (r = 0.9406), with agreement of -6.75 ± 19.07 and significant variation in 7.9%. For Vgluc-lab, r = 0.8549, with agreement of -4.20 ± 28.37 and significant variation in 15.7%. Significant variation was more frequent in patients on noradrenalin (36.4% versus 6.3%; P = 0.03) but not in the subgroup with hypoperfusion. There was discordance regarding clinical management in 25%, 22% and 15% of the cases for Cgluc-strip, Vgluc-lab and Agluc-strip, respectively. CONCLUSION: Cgluc-strip should be avoided, particularly if noradrenalin is being used. This method usually overestimates the true glucose levels and gives rise to management errors. CLINICAL TRIAL REGISTRATION: ACTRN12608000513314 (registered as an observational, cross-sectional study)
Downloads
References
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-10.
Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for manage- ment of severe sepsis and septic shock. Crit Care Med. 2004;32(3):858-73.
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-77.
Vanhorebeek I, Langouche L, Van den Berghe G. Tight blood glucose control with insulin in the ICU: facts and controversies. Chest. 2007;132(1):268-78.
Mebis L, Gunst J, Langouche L, Vanhorebeek I, Van den Berghe G. Indication and practical use of intensive insulin therapy in the critically ill. Curr Opin Crit Care. 2007;13(4):392-8.
Van den Berghe G. How does blood glucose control with insulin save lives in intensive care? J Clin Invest. 2004;114(9):1187-95.
Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449-61.
van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345(19):1359-67.
Van den Berghe G, Wilmer A, Milants I, et al. Intensive insulin therapy in mixed medical/ surgical intensive care units: benefit versus harm. Diabetes. 2006;55(11):3151-9.
Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. 2003;31(2):359-66.
Krinsley JS, Jones RL. Cost analysis of glycemic control in critically ill adult patients. Chest. 2006;129(3):644-50.
Kanji S, Buffie J, Hutton B, et al. Reliability of point-of-care testing for glucose measurement in critically ill adults. Crit Care Med. 2005;33(12):2778-85.
Tang Z, Du X, Louie RF, Kost GJ. Effects of pH on glucose measurements with handheld glucose meters and a portable glucose analyzer for point-of-care testing. Arch Pathol Lab Med. 2000;124(4):577-82.
Tang Z, Louie RF, Lee JH, Lee DM, Miller EE, Kost GJ. Oxygen effects on glucose meter me asurements with glucose dehydrogenase- and oxidase-based test strips for point-of-care testing. Crit Care Med. 2001;29(5):1062-70.
Tang Z, Lee JH, Louie RF, Kost GJ. Effects of different hematocrit levels on glucose me- asurements with handheld meters for point-of-care testing. Arch Pathol Lab Med. 2000;124(8):1135-40.
Atkin SH, Dasmahapatra A, Jaker MA, Chorost MI, Reddy S. Fingerstick glucose determina- tion in shock. Ann Intern Med. 1991;114(12):1020-4.
Kulkarni A, Saxena M, Price G, O’Leary MJ, Jacques T, Myburgh JA. Analysis of blood glucose measurements using capillary and arterial blood samples in intensive care patients. Inten- sive Care Med. 2005;31(1):142-5.
Sylvain HF, Pokorny ME, English SM, et al. Accuracy of fingerstick glucose values in shock patients. Am J Crit Care. 1995;4(1):44-8.
Critchell CD, Savarese V, Callahan A, Aboud C, Jabbour S, Marik P. Accuracy of bedside capillary blood glucose measurements in critically ill patients. Intensive Care Med. 2007;33(12):2079-84.
Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sep- sis Definitions Conference. Crit Care Med. 2003;31(4):1250-6.
Sacks DB, Bernhardt P, Dunka Jr LJ, Goldstein DE, Hortin GL, Mueller P. Point-of-care blood glucose testing in acute and chronic care facilities; approved guideline -se- cond edition. Clinical and Laboratory Standards Institute (CLSI). 2002;22(17):C30- A2. Available from: http://www.clsi.org/source/orders/free/c30-a2.pdf. Accessed in 2009 (Oct 16).
Dunka Jr LJ, Astles JR, Bernhardt P, et al. Glucose monitoring in settings without laboratory support; approved guideline - second edition. Clinical and Laboratory Standards Institute (CLSI). 2005;25(12):AST4-A2. Available from: http://www.clsi.org/source/orders/free/AST04A2F.pdf. Accessed in 2009 (Oct 16).
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307-10.
Finkielman JD, Oyen LJ, Afessa B. Agreement between bedside blood and plasma glucose measurement in the ICU setting. Chest. 2005;127(5):1749-51.
Maser RE, Butler MA, DeCherney GS. Use of arterial blood with bedside glucose reflec- tance meters in an intensive care unit: are they accurate? Crit Care Med. 1994;22(4): 595-9.
FreeStyle. Freedom Lite. Blood glucose monitoring system. Sistema de control del nivel de glucosa en sangre. Owner’s booklet. Manual del propietario. Available from: http://www. abbottdiabetescare.com/static/content/document/ART12214_Rev-B_web.pdf. Accessed in 2009 (Oct 21).
Vriesendorp TM, DeVries JH, van Santen S, et al. Evaluation of short-term consequences of hypoglycemia in an intensive care unit. Crit Care Med. 2006;34(11):2714-8.
Vriesendorp TM, van Santen S, DeVries JH, et al. Predisposing factors for hypoglycemia in the intensive care unit. Crit Care Med. 2006;34(1):96-101.
