Tigecycline-Induced Hypoglycemia in Critically Ill Patients with Severe Infections: A Retrospective Cohort Study

Objective:‌This study assessed the association between tigecycline administration and blood glucose reduction in critically ill patients with severe infections, and identified related risk factors. ‌Methods:‌ Mixed-model repeated measures and generalized estimating equations analyzed blood glucose changes before and after tigecycline treatment. Multivariate linear regression and binary logistic regression identified factors associated with glucose reduction and hypoglycemia. ROC curve analysis evaluated hypoglycemia predictors. ‌Results:‌ Among 169 patients (mean age 64.2±15.8 years), daily blood glucose levels significantly decreased at three time points (6 am, 2 pm, 10 pm) following tigecycline administration, independent of other factors. Glucose reduction correlated significantly with minimum pre-treatment glucose levels, maximum 24-hour glucose decrease, and tigecycline therapy duration. Hypoglycemia occurred in 19 patients (11.2%), associated with higher 28-day mortality (OR=3.83), maximum 24-hour glucose decrease (OR=1.25), lower pre-treatment glucose (OR=0.67), and ICU admission (OR=4.84). The combined predictor (maximum 24-hour glucose decrease + admission type) achieved an AUC of 0.84 (95% CI: 0.75-0.93) with 0.79 sensitivity and 0.79 specificity. ‌Conclusion:‌ Tigecycline administration is associated with decreased blood glucose and may increase short-term mortality in critically ill patients with severe infections. Early monitoring and identification of hypoglycemia risk are recommended during tigecycline therapy.