Intensive care unit hypoglycemia predicts depression during early recovery from acute lung injury
David W Dowdy, Victoriano Dinglas, Pedro A Mendez-Tellez, O Joseph Bienvenu, Jonathan Sevransky, Cheryl R Dennison, Carl Shanholtz, Dale M Needham, David W Dowdy, Victoriano Dinglas, Pedro A Mendez-Tellez, O Joseph Bienvenu, Jonathan Sevransky, Cheryl R Dennison, Carl Shanholtz, Dale M Needham
Abstract
Objective: To evaluate the association between intensive care unit blood glucose levels and depression after acute lung injury.
Design: Prospective cohort study.
Setting: Twelve intensive care units in four hospitals in Baltimore, MD.
Patients: Consecutive acute lung injury survivors (n = 104) monitored during 1717 intensive care unit patient-days and screened for depression at 3 months after acute lung injury.
Interventions: None.
Measurements and main results: The prevalence of a positive screening test for depression (Hospital Anxiety and Depression subscale score > or = 8) at follow-up was 28%. After adjustment for confounders, patients with a mean daily minimum intensive care unit glucose level < 100 mg/dL had significant increases in mean depression score (2.1 points, 95% confidence interval 0.6-3.7) and in the likelihood of a positive depression screening test (relative risk 2.6, 95% confidence interval 1.2-4.2). Patients with documented hypoglycemia < 60 mg/dL during their intensive care unit stay also had greater symptoms of depression (2.0 points, 95% confidence interval 0.5-3.5; relative risk 3.6, 95% confidence interval 1.8-5.1). Other factors independently associated with a positive depression screening test included body mass index > 40 kg/m2 (relative risk 3.3, 95% confidence interval 1.2-4.2), baseline depression/anxiety (relative risk 3.9, 95% confidence interval 1.5-6.5), and mean daily intensive care unit benzodiazepine dose > 100 mg of midazolam-equivalent agent (relative risk 2.4, 95% confidence interval 1.1-3.8).
Conclusions: Hypoglycemia in the intensive care unit is associated with an increased risk of positive screening for depression during early recovery from acute lung injury. Baseline depressive symptoms, morbid obesity, and intensive care unit benzodiazepine dose were also associated with postacute lung injury depressive symptoms. These findings warrant increased glucose monitoring for intensive care unit patients at risk for hypoglycemia and further research on how patient and intensive care unit management factors may contribute to postintensive care unit depression.
Conflict of interest statement
The authors have not disclosed any potential conflicts of interest.
Figures
![Figure 1. Study Flow Diagram](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2605796/bin/nihms76348f1.jpg)
![Figure 2. Depression during Early Recovery from…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2605796/bin/nihms76348f2a.jpg)
Figure 2. Depression during Early Recovery from…
Figure 2. Depression during Early Recovery from Acute Lung Injury, by ICU Blood Glucose Levels
Figure 2. Depression during Early Recovery from…
Figure 2. Depression during Early Recovery from Acute Lung Injury, by ICU Blood Glucose Levels
Figure 3. Effect of Documented Hypoglycemia and…
Figure 3. Effect of Documented Hypoglycemia and Mean Daily Minimum ICU Blood Glucose on Depression…
- Unhappy acute lung injury survivors: the case of hypoglycemicly-induced depressive symptoms.Dijkgraaf MG. Dijkgraaf MG. Crit Care Med. 2008 Oct;36(10):2931-2. doi: 10.1097/CCM.0b013e318187b724. Crit Care Med. 2008. PMID: 18812794 No abstract available.
- Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury.Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, McAuley DF. Craig TR, et al. Crit Care Med. 2010 Jan;38(1):114-20. doi: 10.1097/CCM.0b013e3181b43050. Crit Care Med. 2010. PMID: 19789451
- Are intensive care factors associated with depressive symptoms 6 months after acute lung injury?Dowdy DW, Bienvenu OJ, Dinglas VD, Mendez-Tellez PA, Sevransky J, Shanholtz C, Needham DM. Dowdy DW, et al. Crit Care Med. 2009 May;37(5):1702-7. doi: 10.1097/CCM.0b013e31819fea55. Crit Care Med. 2009. PMID: 19357507 Free PMC article.
- Predisposing factors for hypoglycemia in the intensive care unit.Vriesendorp TM, van Santen S, DeVries JH, de Jonge E, Rosendaal FR, Schultz MJ, Hoekstra JB. Vriesendorp TM, et al. Crit Care Med. 2006 Jan;34(1):96-101. doi: 10.1097/01.ccm.0000194536.89694.06. Crit Care Med. 2006. PMID: 16374162
- Unhappy acute lung injury survivors: the case of hypoglycemicly-induced depressive symptoms.Dijkgraaf MG. Dijkgraaf MG. Crit Care Med. 2008 Oct;36(10):2931-2. doi: 10.1097/CCM.0b013e318187b724. Crit Care Med. 2008. PMID: 18812794 No abstract available.
- Suicidal Ideation.Harmer B, Lee S, Duong TVH, Saadabadi A. Harmer B, et al. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33351435 Free Books & Documents.
- Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review.Vrettou CS, Mantziou V, Vassiliou AG, Orfanos SE, Kotanidou A, Dimopoulou I. Vrettou CS, et al. Life (Basel). 2022 Jan 12;12(1):107. doi: 10.3390/life12010107. Life (Basel). 2022. PMID: 35054500 Free PMC article. Review.
- Participant Retention in Follow-Up Studies of Acute Respiratory Failure Survivors.Nunna K, Al-Ani A, Nikooie R, Friedman LA, Raman V, Wadood Z, Vasishta S, Colantuoni E, Needham DM, Dinglas VD. Nunna K, et al. Respir Care. 2020 Sep;65(9):1382-1391. doi: 10.4187/respcare.07461. Epub 2020 Mar 31. Respir Care. 2020. PMID: 32234765 Free PMC article. Review.
- The quality of acute intensive care and the incidence of critical events have an impact on health-related quality of life in survivors of the acute respiratory distress syndrome - a nationwide prospective multicenter observational study.Bein T, Weber-Carstens S, Apfelbacher C, Brandstetter S, Blecha S, Dodoo-Schittko F, Brandl M, Quintel M, Kluge S, Putensen C, Bercker S, Ellger B, Kirschning T, Arndt C, Meybohm P, Zeman F, Karagiannidis C. Bein T, et al. Ger Med Sci. 2020 Jan 20;18:Doc01. doi: 10.3205/000277. eCollection 2020. Ger Med Sci. 2020. PMID: 32047416 Free PMC article.
- Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit.LaBuzetta JN, Rosand J, Vranceanu AM. LaBuzetta JN, et al. Neurocrit Care. 2019 Dec;31(3):534-545. doi: 10.1007/s12028-019-00826-0. Neurocrit Care. 2019. PMID: 31486026 Free PMC article. Review.
- Acute respiratory distress syndrome.Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, Herridge M, Randolph AG, Calfee CS. Matthay MA, et al. Nat Rev Dis Primers. 2019 Mar 14;5(1):18. doi: 10.1038/s41572-019-0069-0. Nat Rev Dis Primers. 2019. PMID: 30872586 Free PMC article. Review.
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Adult
- Analysis of Variance
- Blood Glucose / analysis
- Cohort Studies
- Combined Modality Therapy
- Critical Care / methods*
- Depressive Disorder / epidemiology*
- Depressive Disorder / etiology*
- Depressive Disorder / physiopathology
- Female
- Follow-Up Studies
- Humans
- Hypoglycemia / complications
- Hypoglycemia / diagnosis*
- Hypoglycemia / therapy
- Incidence
- Intensive Care Units
- Logistic Models
- Male
- Middle Aged
- Patient Discharge
- Predictive Value of Tests
- Probability
- Prospective Studies
- Respiratory Distress Syndrome / complications
- Respiratory Distress Syndrome / diagnosis
- Respiratory Distress Syndrome / mortality
- Respiratory Distress Syndrome / therapy*
- Risk Assessment
- Survival Analysis
- Treatment Outcome
- Blood Glucose
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![Figure 2. Depression during Early Recovery from…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2605796/bin/nihms76348f2b.jpg)
Figure 2. Depression during Early Recovery from…
Figure 2. Depression during Early Recovery from Acute Lung Injury, by ICU Blood Glucose Levels
Figure 3. Effect of Documented Hypoglycemia and…
Figure 3. Effect of Documented Hypoglycemia and Mean Daily Minimum ICU Blood Glucose on Depression…
- Unhappy acute lung injury survivors: the case of hypoglycemicly-induced depressive symptoms.Dijkgraaf MG. Dijkgraaf MG. Crit Care Med. 2008 Oct;36(10):2931-2. doi: 10.1097/CCM.0b013e318187b724. Crit Care Med. 2008. PMID: 18812794 No abstract available.
- Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury.Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, McAuley DF. Craig TR, et al. Crit Care Med. 2010 Jan;38(1):114-20. doi: 10.1097/CCM.0b013e3181b43050. Crit Care Med. 2010. PMID: 19789451
- Are intensive care factors associated with depressive symptoms 6 months after acute lung injury?Dowdy DW, Bienvenu OJ, Dinglas VD, Mendez-Tellez PA, Sevransky J, Shanholtz C, Needham DM. Dowdy DW, et al. Crit Care Med. 2009 May;37(5):1702-7. doi: 10.1097/CCM.0b013e31819fea55. Crit Care Med. 2009. PMID: 19357507 Free PMC article.
- Predisposing factors for hypoglycemia in the intensive care unit.Vriesendorp TM, van Santen S, DeVries JH, de Jonge E, Rosendaal FR, Schultz MJ, Hoekstra JB. Vriesendorp TM, et al. Crit Care Med. 2006 Jan;34(1):96-101. doi: 10.1097/01.ccm.0000194536.89694.06. Crit Care Med. 2006. PMID: 16374162
- Unhappy acute lung injury survivors: the case of hypoglycemicly-induced depressive symptoms.Dijkgraaf MG. Dijkgraaf MG. Crit Care Med. 2008 Oct;36(10):2931-2. doi: 10.1097/CCM.0b013e318187b724. Crit Care Med. 2008. PMID: 18812794 No abstract available.
- Suicidal Ideation.Harmer B, Lee S, Duong TVH, Saadabadi A. Harmer B, et al. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33351435 Free Books & Documents.
- Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review.Vrettou CS, Mantziou V, Vassiliou AG, Orfanos SE, Kotanidou A, Dimopoulou I. Vrettou CS, et al. Life (Basel). 2022 Jan 12;12(1):107. doi: 10.3390/life12010107. Life (Basel). 2022. PMID: 35054500 Free PMC article. Review.
- Participant Retention in Follow-Up Studies of Acute Respiratory Failure Survivors.Nunna K, Al-Ani A, Nikooie R, Friedman LA, Raman V, Wadood Z, Vasishta S, Colantuoni E, Needham DM, Dinglas VD. Nunna K, et al. Respir Care. 2020 Sep;65(9):1382-1391. doi: 10.4187/respcare.07461. Epub 2020 Mar 31. Respir Care. 2020. PMID: 32234765 Free PMC article. Review.
- The quality of acute intensive care and the incidence of critical events have an impact on health-related quality of life in survivors of the acute respiratory distress syndrome - a nationwide prospective multicenter observational study.Bein T, Weber-Carstens S, Apfelbacher C, Brandstetter S, Blecha S, Dodoo-Schittko F, Brandl M, Quintel M, Kluge S, Putensen C, Bercker S, Ellger B, Kirschning T, Arndt C, Meybohm P, Zeman F, Karagiannidis C. Bein T, et al. Ger Med Sci. 2020 Jan 20;18:Doc01. doi: 10.3205/000277. eCollection 2020. Ger Med Sci. 2020. PMID: 32047416 Free PMC article.
- Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit.LaBuzetta JN, Rosand J, Vranceanu AM. LaBuzetta JN, et al. Neurocrit Care. 2019 Dec;31(3):534-545. doi: 10.1007/s12028-019-00826-0. Neurocrit Care. 2019. PMID: 31486026 Free PMC article. Review.
- Acute respiratory distress syndrome.Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, Herridge M, Randolph AG, Calfee CS. Matthay MA, et al. Nat Rev Dis Primers. 2019 Mar 14;5(1):18. doi: 10.1038/s41572-019-0069-0. Nat Rev Dis Primers. 2019. PMID: 30872586 Free PMC article. Review.
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Adult
- Analysis of Variance
- Blood Glucose / analysis
- Cohort Studies
- Combined Modality Therapy
- Critical Care / methods*
- Depressive Disorder / epidemiology*
- Depressive Disorder / etiology*
- Depressive Disorder / physiopathology
- Female
- Follow-Up Studies
- Humans
- Hypoglycemia / complications
- Hypoglycemia / diagnosis*
- Hypoglycemia / therapy
- Incidence
- Intensive Care Units
- Logistic Models
- Male
- Middle Aged
- Patient Discharge
- Predictive Value of Tests
- Probability
- Prospective Studies
- Respiratory Distress Syndrome / complications
- Respiratory Distress Syndrome / diagnosis
- Respiratory Distress Syndrome / mortality
- Respiratory Distress Syndrome / therapy*
- Risk Assessment
- Survival Analysis
- Treatment Outcome
- Blood Glucose
- T32 GM007309/GM/NIGMS NIH HHS/United States
- T32 GMO7309/PHS HHS/United States
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- P50 HL073994/HL/NHLBI NIH HHS/United States
- P050 HL 73994/HL/NHLBI NIH HHS/United States
- Full Text Sources
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- Medical
NCBI Literature Resources
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
![Figure 2. Depression during Early Recovery from…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2605796/bin/nihms76348f2c.jpg)
Figure 3. Effect of Documented Hypoglycemia and…
Figure 3. Effect of Documented Hypoglycemia and Mean Daily Minimum ICU Blood Glucose on Depression…
- Unhappy acute lung injury survivors: the case of hypoglycemicly-induced depressive symptoms.Dijkgraaf MG. Dijkgraaf MG. Crit Care Med. 2008 Oct;36(10):2931-2. doi: 10.1097/CCM.0b013e318187b724. Crit Care Med. 2008. PMID: 18812794 No abstract available.
- Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury.Craig TR, Duffy MJ, Shyamsundar M, McDowell C, McLaughlin B, Elborn JS, McAuley DF. Craig TR, et al. Crit Care Med. 2010 Jan;38(1):114-20. doi: 10.1097/CCM.0b013e3181b43050. Crit Care Med. 2010. PMID: 19789451
- Are intensive care factors associated with depressive symptoms 6 months after acute lung injury?Dowdy DW, Bienvenu OJ, Dinglas VD, Mendez-Tellez PA, Sevransky J, Shanholtz C, Needham DM. Dowdy DW, et al. Crit Care Med. 2009 May;37(5):1702-7. doi: 10.1097/CCM.0b013e31819fea55. Crit Care Med. 2009. PMID: 19357507 Free PMC article.
- Predisposing factors for hypoglycemia in the intensive care unit.Vriesendorp TM, van Santen S, DeVries JH, de Jonge E, Rosendaal FR, Schultz MJ, Hoekstra JB. Vriesendorp TM, et al. Crit Care Med. 2006 Jan;34(1):96-101. doi: 10.1097/01.ccm.0000194536.89694.06. Crit Care Med. 2006. PMID: 16374162
- Unhappy acute lung injury survivors: the case of hypoglycemicly-induced depressive symptoms.Dijkgraaf MG. Dijkgraaf MG. Crit Care Med. 2008 Oct;36(10):2931-2. doi: 10.1097/CCM.0b013e318187b724. Crit Care Med. 2008. PMID: 18812794 No abstract available.
- Suicidal Ideation.Harmer B, Lee S, Duong TVH, Saadabadi A. Harmer B, et al. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33351435 Free Books & Documents.
- Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review.Vrettou CS, Mantziou V, Vassiliou AG, Orfanos SE, Kotanidou A, Dimopoulou I. Vrettou CS, et al. Life (Basel). 2022 Jan 12;12(1):107. doi: 10.3390/life12010107. Life (Basel). 2022. PMID: 35054500 Free PMC article. Review.
- Participant Retention in Follow-Up Studies of Acute Respiratory Failure Survivors.Nunna K, Al-Ani A, Nikooie R, Friedman LA, Raman V, Wadood Z, Vasishta S, Colantuoni E, Needham DM, Dinglas VD. Nunna K, et al. Respir Care. 2020 Sep;65(9):1382-1391. doi: 10.4187/respcare.07461. Epub 2020 Mar 31. Respir Care. 2020. PMID: 32234765 Free PMC article. Review.
- The quality of acute intensive care and the incidence of critical events have an impact on health-related quality of life in survivors of the acute respiratory distress syndrome - a nationwide prospective multicenter observational study.Bein T, Weber-Carstens S, Apfelbacher C, Brandstetter S, Blecha S, Dodoo-Schittko F, Brandl M, Quintel M, Kluge S, Putensen C, Bercker S, Ellger B, Kirschning T, Arndt C, Meybohm P, Zeman F, Karagiannidis C. Bein T, et al. Ger Med Sci. 2020 Jan 20;18:Doc01. doi: 10.3205/000277. eCollection 2020. Ger Med Sci. 2020. PMID: 32047416 Free PMC article.
- Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit.LaBuzetta JN, Rosand J, Vranceanu AM. LaBuzetta JN, et al. Neurocrit Care. 2019 Dec;31(3):534-545. doi: 10.1007/s12028-019-00826-0. Neurocrit Care. 2019. PMID: 31486026 Free PMC article. Review.
- Acute respiratory distress syndrome.Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, Herridge M, Randolph AG, Calfee CS. Matthay MA, et al. Nat Rev Dis Primers. 2019 Mar 14;5(1):18. doi: 10.1038/s41572-019-0069-0. Nat Rev Dis Primers. 2019. PMID: 30872586 Free PMC article. Review.
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Adult
- Analysis of Variance
- Blood Glucose / analysis
- Cohort Studies
- Combined Modality Therapy
- Critical Care / methods*
- Depressive Disorder / epidemiology*
- Depressive Disorder / etiology*
- Depressive Disorder / physiopathology
- Female
- Follow-Up Studies
- Humans
- Hypoglycemia / complications
- Hypoglycemia / diagnosis*
- Hypoglycemia / therapy
- Incidence
- Intensive Care Units
- Logistic Models
- Male
- Middle Aged
- Patient Discharge
- Predictive Value of Tests
- Probability
- Prospective Studies
- Respiratory Distress Syndrome / complications
- Respiratory Distress Syndrome / diagnosis
- Respiratory Distress Syndrome / mortality
- Respiratory Distress Syndrome / therapy*
- Risk Assessment
- Survival Analysis
- Treatment Outcome
- Blood Glucose
- T32 GM007309/GM/NIGMS NIH HHS/United States
- T32 GMO7309/PHS HHS/United States
- K23 NR009193-03/NR/NINR NIH HHS/United States
- K23 MH64543/MH/NIMH NIH HHS/United States
- K23 MH064543/MH/NIMH NIH HHS/United States
- P50 HL073994-01/HL/NHLBI NIH HHS/United States
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- P50 HL073994/HL/NHLBI NIH HHS/United States
- P050 HL 73994/HL/NHLBI NIH HHS/United States
- Full Text Sources
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- Medical
![Figure 3. Effect of Documented Hypoglycemia and…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2605796/bin/nihms76348f3.jpg)
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