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Supplemental Digital Content:
Definitions:
1. Time-Weighted Average Daily Glucose Calculation:
The time-weighted average daily glucose (ADG) calculation is performed by first sequencing all available
glucose values, regardless of source, for each ICU patient. Each patient day is determined by 24 hour intervals
originating from the time of ICU admission. The ADG is determined by calculating the total area under the
curve for each patient day via the trapezoidal rule described below:
AUC = [(X1 + X2) (T2 – T1) + (X2 + X3) (T3 – T2) + (X3 + X4)
(T4 – T3) + . . . + (Xn–1 + Xn) (Tn – Tn–1)]/2,
where Xn is the glucose value, X1 is the first glucose value of the day, Xn is the last value in the same calendar
day, and Tn is the time the glucose value is taken. The time-weighted average will be the AUC calculated as
above, divided by the time (Tn – T1).
2. ICU-acquired Respiratory Failure
Patient ICU stays are counted as having ICU-acquired Respiratory Failure if they meet the following
criteria:
Patient stays are excluded from consideration for ICU-acquired respiratory failure if any of these
criteria are present: A primary admission diagnosis associated with respiratory failure; a diagnosis of
respiratory failure that occurs less than or equal to 48 hours after ICU admission.
The patient has a new diagnosis indicating Respiratory Failure that occurs > 48 hours after ICU
admission AND the patient has evidence of mechanical ventilation > 48 hours after ICU admission.
3. ICU-acquired Renal Injury
Patient ICU stays are counted as having ICU-acquired Renal Injury if they meet the following criteria:
The patient has evidence of renal injury > 72 hours after ICU admission that was not present during
the first 72 hours of the ICU stay. Evidence of new renal injury comes from documentation of
diagnoses and laboratory values.
Patients are excluded from consideration for ICU-acquired renal injury if any of the following criteria
are present: any diagnosis related to acute renal failure or dialysis documented with the first 72
hours of the ICU stay; past medical history of chronic renal failure; or a baseline serum creatinine
value > 530.4 µmol/l (6mg/dL).
Patients are included by diagnosis criteria if there is any diagnosis related to acute renal failure or
dialysis documented > 72 hours after ICU admission.
Patients are included by laboratory criteria if the patient has either 1) a creatinine value greater than
or equal to 2-times the baseline creatinine AND greater than 141.4 µmol/L (1.6 mg/dL ) or 2) a
creatinine value that increased greater than 176.8 µmol/L (2 mg/dL) over the baseline value.
4. ICU-acquired Upper Gastrointestinal (GI) Bleeding
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Patient ICU stays are counted as having ICU-acquired Upper GI Bleeding if they meet the following
criteria:
The patient has evidence of an upper GI bleed > 48 hours after ICU admission that was not present
during the first 48 hours of the ICU stay. Evidence of a new upper GI bleed comes from
documentation of diagnoses and laboratory values.
Patients are excluded from consideration for ICU-acquired upper GI bleeding if any of the following
criteria are present: admission diagnosis of upper GI bleeding or an active diagnosis of upper GI
bleeding within the first 48 hours of the ICU stay.
Patients are included as having an ICU-acquired upper GI bleed if they had an active diagnosis of
upper GI Bleeding occurring > 48 hours after ICU admission and there was evidence of active bleeding
defined by: at least 1 unit of blood transfused or at least 10 g/L (1 g/dL) drop in hemoglobin within 36
hours of the diagnosis.
5. ICU-acquired Sepsis
Patient ICU stays are counted as having ICU-acquired sepsis if they meet the following criteria:
The patient has evidence of sepsis > 48 hours after ICU admission that was not present during the
first 48 hours of the ICU stay.
Patients are excluded from consideration for ICU-acquired sepsis if they had either an admission
diagnosis of sepsis or an active diagnosis of sepsis within the first 48 hours of the ICU stay.
Patients are included as having ICU-acquired sepsis if they had a diagnosis of sepsis that occurred >
48 hours after ICU admission.
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