human
***task***
the task is to summarize an input biomedical literature in six sentences

***input***
the input is a biomedical literature

***output***
the output is the summary of an input biomedical literature in six sentences

***documentation***

***examples***

input: partners healthcare human research committee approved the protocol and waived the requirement for written informed consent . hospitalized patients with one or more blood glucose values 50 mg / dl on point - of - care blood glucose testing were included in this study . the exact date and time of hypoglycemiadetailed demographic data and hospitalization records that included all diagnoses , some laboratory reports , and prescribed medications were obtained from the rpdr . if multiple hospitalizations were present for a particular patient , the last hospitalization was used in the analysis . if a patient had suffered more than one hypoglycemic episode during hospitalization , the first episode of hypoglycemia was considered the key event . when insulin was used during hospitalizationmortality data during hospitalization were obtained , and the time period between hypoglycemia and death was noted . a control group of patients admitted during the same time period ( 1 april 2008 to 30 november 2010 ) with no blood glucose value 70 mg / dl on point - of - care blood glucose testing was selected . for each sex / race / age decadecharacteristic combination among hypoglycemic patients , we obtained matched controls with the same characteristic combination , aiming for the number of controls to be twice the number of cases for each characteristic combination . the resulting number of controls was less than twice the number of hypoglycemic patients due to limited availability . if there were multiple hospitalizations for a control patient , the last hospitalization was used in the analysis . insulin usage and death during hospitalization were noted . data were summarized as numbers with percentage or means and sd . the charlson comorbidity index ( cci ) patient characteristics were compared between groups using wilcoxon rank sum test , test , or logistic regression for mortality . groups were compared in terms of the time from hypoglycemia to death during hospitalization or censoring at discharge using the log - rank test and kaplan - meier plot . cox regression was used to assess the significance of single and simultaneous multiple predictors of death , with hazard ratios ( hrs ) and 95 % cis , accounting for intracluster dependence resulting from the method of selecting the control group ( 9 ) . potential confounders of group comparisons included the cci and admission to the intensive care unit ( icu ) , insulin , age , sex , and race . the retention of covariates in the final model depended on the association with mortality ( p 0.10 ) . hospitalized patients with one or more blood glucose values 50 mg / dl on point - of - care blood glucose testing were included in this study . the exact date and time of hypoglycemiadetailed demographic data and hospitalization records that included all diagnoses , some laboratory reports , and prescribed medications were obtained from the rpdr . if multiple hospitalizations were present for a particular patient , the last hospitalization was used in the analysis . if a patient had suffered more than one hypoglycemic episode during hospitalization , the first episode of hypoglycemia was considered the key event . when insulin was used during hospitalizationmortality data during hospitalization were obtained , and the time period between hypoglycemia and death was noted . a control group of patients admitted during the same time period ( 1 april 2008 to 30 november 2010 ) with no blood glucose value 70 mg / dl on point - of - care blood glucose testing was selected . for each sex / race / age decadecharacteristic combination among hypoglycemic patients , we obtained matched controls with the same characteristic combination , aiming for the number of controls to be twice the number of cases for each characteristic combination . the resulting number of controls was less than twice the number of hypoglycemic patients due to limited availability . if there were multiple hospitalizations for a control patient , the last hospitalization was used in the analysis . insulin usage and death during hospitalization were noted . data were summarized as numbers with percentage or means and sd . the charlson comorbidity index ( cci ) patient characteristics were compared between groups using wilcoxon rank sum test , test , or logistic regression for mortality . groups were compared in terms of the time from hypoglycemia to death during hospitalization or censoring at discharge using the log - rank test and kaplan - meier plot . cox regression was used to assess the significance of single and simultaneous multiple predictors of death , with hazard ratios ( hrs ) and 95 % cis , accounting for intracluster dependence resulting from the method of selecting the control group ( 9 ) . potential confounders of group comparisons included the cci and admission to the intensive care unit ( icu ) , insulin , age , sex , and race . the retention of covariates in the final model depended on the association with mortality ( p 0.10 ) . a total of 2,890 patients were included in this study and divided into four groups : 1 ) noninsulin - treated hypoglycemia ( nth ) ( n = 135 ) , 2 ) insulin - treated hypoglycemia ( ith ) ( n = 961 ) , 3 ) noninsulin - treated control ( ntc ) ( n = 1,058 ) , and 4 ) insulin - treated control ( itc ) ( n = 736 ) . they were sicker , as indicated by higher cci and more admissions to the icu . mortality among hypoglycemic patients was nine times higher than mortality among control patients ( 22.1 vs. 2.5 % ; p 0.0001 ) . differences between insulin - treated versus noninsulin - treated groups are shown in table 1 . insulin - treated hypoglycemic patients as well as the itc patients were older and more likely to have a diagnosis of diabetes . patients in the nth group were sicker with a higher cci and more admissions to the icu as compared with the ith group , a relation that was reversed in the control group , with ntc patients having a lower cci than itc patients . mortality during hospitalization was higher in the nth group compared with the ith group ( p 0.0001 ) but lower in the ntc group compared with the itc group ( p 0.0001 ) . mortality was higher in the ith group compared with the itc group ( 20.3 vs. 4.5 % , p 0.0001 ) , with a relatively small difference in the cci ( 1.8 vs. 1.5 % , p 0.0001 ) , but much higher in the nth group compared with the ntc group ( 34.5 vs. 1.1 % , p 0.0001 ) , with much higher cci ( 2.4 vs. 1.1 % , p 0.0001 ) . mortality during hospitalization was highest in the nth group followed by the ith and itc groups . patient characteristics and group comparisons on univariate regression analysis , the cci and admission to the icu were associated with higher mortality , whereas female sex and insulin treatment were associated with lower mortality ( table 2 ) . the hr for death in the ith group relative to the nth group in a multiple variable model that included cci , age , sex , and admission to the icu as covariates was 0.34 ( 95 % ci 0.250.47 , p 0.0001 ) ( table 3 ) . the kaplan - meier plot depicts better survival after hypoglycemia in insulin - treated patients compared with spontaneous hypoglycemic patients , especially in the first 2 weeks , where most of the data were concentrated ( fig .1 ) . analysis of individual variables predicting mortality after hypoglycemia ( n = 1,096 ) multiple variable model predicting mortality after hypoglycemia ( n = 1,096 ) plot of survival after the first episode of hypoglycemia for the ith group versus the nth group . this study shows that hypoglycemia in hospitalized patients , whether insulin induced or spontaneous , is associated with increased mortality as compared with absence of hypoglycemia . as expected , insulin - treated patients in our study were more likely to have diabetes and were older than the noninsulin - treated patients . higher mortality in the itc group compared with the ntc group may be due to their older age and higher prevalence of diabetes . however , the presence of hypoglycemia in insulin - treated patients increased their risk of death several - fold compared with itc patients , even though this risk was lower than that in spontaneously hypoglycemic patients . this finding is in contrast to the previous studies that showed that insulin - induced hypoglycemia ( 70 mg / dl ) was not associated with increased risk of mortality ( 1,7 ) . our study is different from previous studies due to a different patient population and inclusion of patients with more severe hypoglycemia . nonetheless , in our study , insulin was highly associated with longer survival and icu admission was highly associated with shorter survival in patients with hypoglycemia . although early trials of tight glycemic control in critically ill hospitalized patients showed benefits of tight glycemic control , subsequent trials either failed to show benefits or ended early due to the risk of hypoglycemia ( 1014 ) . one of the potential explanations for the failure of tight glycemic control has been the high risk of hypoglycemia . most studies , in the inpatient setting as well as in the outpatient setting , have demonstrated that spontaneous hypoglycemia is associated with increased mortality as compared with insulin - induced hypoglycemia , and our study supports these data ( 7,16,17 ) . however , our study also shows that mortality in the ith group was still very high , suggesting only a partial , if any , protective effect of insulin . this was a single - center study , and the sample size for the spontaneous hypoglycemia group was rather small . also , we did not have details about the type of diabetes , duration of diabetes , insulin regimens , or glucose control . we assumed that hypoglycemia in insulin - treated patients was insulin associated even though we did not have information about the exact time of insulin injection and the relation between insulin injection and hypoglycemia . furthermore , our analyses did not include adjustments for several confounders , including serum creatinine , hematocrit , albumin , and the use of other medications , including steroids . however , we did control for comorbidity and the severity of illness by including the cci and admission to the icu . we think these data provide valuable information on the relation between hypoglycemia and mortality in the inpatient setting . we conclude that insulin - induced hypoglycemia as well as spontaneous hypoglycemia is associated with increased mortality among hospitalized patients . prospective studies are needed to determine whether the prevention of hypoglycemia improves outcome in hospitalized patients .
output:

agent
objectivehypoglycemia is associated with increased mortality in hospitalized patients . we investigated the relationship between spontaneous hypoglycemia versus insulin - associated hypoglycemia and mortality in hospitalized patients.research design and methodsdata for this retrospective cohort study were obtained from electronic databases of patients admitted between 1 april 2008 and 30 november 2010 . patients with one or more blood glucose values 50 mg / dl on point - of - care glucose testing were considered hypoglycemic . patients treated with insulin were assumed to have insulin - associated hypoglycemia . age - , sex - , and race - matched patients with all blood glucose values > 70 mg / dl were selected as controls . the charlson comorbidity index ( cci ) was used to control for severity of illness.resultsthere were four groups : 1 ) noninsulin - treated hypoglycemia ( nth ) ( n = 135 ) , 2 ) insulin - treated hypoglycemia ( ith ) ( n = 961 ) , 3 ) noninsulin - treated control ( ntc ) ( n = 1,058 ) , and 4 ) insulin - treated control ( itc ) ( n = 736 ) . mortality was higher in the ith group compared with the itc group ( 20.3 vs. 4.5 % , p < 0.0001 ) , with a relatively higher cci ( 1.8 vs. 1.5 % , p < 0.0001 ) , but much higher in the nth group compared with the ntc group ( 34.5 vs. 1.1 % , p < 0.0001 ) , with much higher cci ( 2.4 vs. 1.1 % , p < 0.0001 ) . mortality was higher in the nth group compared with the ith group ( p < 0.0001 ) but lower in the ntc group compared with the itc group ( p < 0.0001 ) . after controlling for age , sex , cci , and admission to the intensive care unit , insulin treatment was associated with a lower mortality among the hypoglycemic patients ; hazard ratio of death in the ith group relative to the nth group was 0.34 ( 95 % ci 0.250.47 , p < 0.0001 ) . conclusionsinsulin - associated and spontaneous hypoglycemia are associated with increased mortality among hospitalized patients .
***task***
the task is to summarize an input biomedical literature in six sentences

***input***
the input is a biomedical literature

***output***
the output is the summary of an input biomedical literature in six sentences

***documentation***

***examples***

input: partners healthcare human research committee approved the protocol and waived the requirement for written informed consent . hospitalized patients with one or more blood glucose values 50 mg / dl on point - of - care blood glucose testing were included in this study . the exact date and time of hypoglycemiadetailed demographic data and hospitalization records that included all diagnoses , some laboratory reports , and prescribed medications were obtained from the rpdr . if multiple hospitalizations were present for a particular patient , the last hospitalization was used in the analysis . if a patient had suffered more than one hypoglycemic episode during hospitalization , the first episode of hypoglycemia was considered the key event . when insulin was used during hospitalizationmortality data during hospitalization were obtained , and the time period between hypoglycemia and death was noted . a control group of patients admitted during the same time period ( 1 april 2008 to 30 november 2010 ) with no blood glucose value 70 mg / dl on point - of - care blood glucose testing was selected . for each sex / race / age decadecharacteristic combination among hypoglycemic patients , we obtained matched controls with the same characteristic combination , aiming for the number of controls to be twice the number of cases for each characteristic combination . the resulting number of controls was less than twice the number of hypoglycemic patients due to limited availability . if there were multiple hospitalizations for a control patient , the last hospitalization was used in the analysis . insulin usage and death during hospitalization were noted . data were summarized as numbers with percentage or means and sd . the charlson comorbidity index ( cci ) patient characteristics were compared between groups using wilcoxon rank sum test , test , or logistic regression for mortality . groups were compared in terms of the time from hypoglycemia to death during hospitalization or censoring at discharge using the log - rank test and kaplan - meier plot . cox regression was used to assess the significance of single and simultaneous multiple predictors of death , with hazard ratios ( hrs ) and 95 % cis , accounting for intracluster dependence resulting from the method of selecting the control group ( 9 ) . potential confounders of group comparisons included the cci and admission to the intensive care unit ( icu ) , insulin , age , sex , and race . the retention of covariates in the final model depended on the association with mortality ( p 0.10 ) . hospitalized patients with one or more blood glucose values 50 mg / dl on point - of - care blood glucose testing were included in this study . the exact date and time of hypoglycemiadetailed demographic data and hospitalization records that included all diagnoses , some laboratory reports , and prescribed medications were obtained from the rpdr . if multiple hospitalizations were present for a particular patient , the last hospitalization was used in the analysis . if a patient had suffered more than one hypoglycemic episode during hospitalization , the first episode of hypoglycemia was considered the key event . when insulin was used during hospitalizationmortality data during hospitalization were obtained , and the time period between hypoglycemia and death was noted . a control group of patients admitted during the same time period ( 1 april 2008 to 30 november 2010 ) with no blood glucose value 70 mg / dl on point - of - care blood glucose testing was selected . for each sex / race / age decadecharacteristic combination among hypoglycemic patients , we obtained matched controls with the same characteristic combination , aiming for the number of controls to be twice the number of cases for each characteristic combination . the resulting number of controls was less than twice the number of hypoglycemic patients due to limited availability . if there were multiple hospitalizations for a control patient , the last hospitalization was used in the analysis . insulin usage and death during hospitalization were noted . data were summarized as numbers with percentage or means and sd . the charlson comorbidity index ( cci ) patient characteristics were compared between groups using wilcoxon rank sum test , test , or logistic regression for mortality . groups were compared in terms of the time from hypoglycemia to death during hospitalization or censoring at discharge using the log - rank test and kaplan - meier plot . cox regression was used to assess the significance of single and simultaneous multiple predictors of death , with hazard ratios ( hrs ) and 95 % cis , accounting for intracluster dependence resulting from the method of selecting the control group ( 9 ) . potential confounders of group comparisons included the cci and admission to the intensive care unit ( icu ) , insulin , age , sex , and race . the retention of covariates in the final model depended on the association with mortality ( p 0.10 ) . a total of 2,890 patients were included in this study and divided into four groups : 1 ) noninsulin - treated hypoglycemia ( nth ) ( n = 135 ) , 2 ) insulin - treated hypoglycemia ( ith ) ( n = 961 ) , 3 ) noninsulin - treated control ( ntc ) ( n = 1,058 ) , and 4 ) insulin - treated control ( itc ) ( n = 736 ) . they were sicker , as indicated by higher cci and more admissions to the icu . mortality among hypoglycemic patients was nine times higher than mortality among control patients ( 22.1 vs. 2.5 % ; p 0.0001 ) . differences between insulin - treated versus noninsulin - treated groups are shown in table 1 . insulin - treated hypoglycemic patients as well as the itc patients were older and more likely to have a diagnosis of diabetes . patients in the nth group were sicker with a higher cci and more admissions to the icu as compared with the ith group , a relation that was reversed in the control group , with ntc patients having a lower cci than itc patients . mortality during hospitalization was higher in the nth group compared with the ith group ( p 0.0001 ) but lower in the ntc group compared with the itc group ( p 0.0001 ) . mortality was higher in the ith group compared with the itc group ( 20.3 vs. 4.5 % , p 0.0001 ) , with a relatively small difference in the cci ( 1.8 vs. 1.5 % , p 0.0001 ) , but much higher in the nth group compared with the ntc group ( 34.5 vs. 1.1 % , p 0.0001 ) , with much higher cci ( 2.4 vs. 1.1 % , p 0.0001 ) . mortality during hospitalization was highest in the nth group followed by the ith and itc groups . patient characteristics and group comparisons on univariate regression analysis , the cci and admission to the icu were associated with higher mortality , whereas female sex and insulin treatment were associated with lower mortality ( table 2 ) . the hr for death in the ith group relative to the nth group in a multiple variable model that included cci , age , sex , and admission to the icu as covariates was 0.34 ( 95 % ci 0.250.47 , p 0.0001 ) ( table 3 ) . the kaplan - meier plot depicts better survival after hypoglycemia in insulin - treated patients compared with spontaneous hypoglycemic patients , especially in the first 2 weeks , where most of the data were concentrated ( fig .1 ) . analysis of individual variables predicting mortality after hypoglycemia ( n = 1,096 ) multiple variable model predicting mortality after hypoglycemia ( n = 1,096 ) plot of survival after the first episode of hypoglycemia for the ith group versus the nth group . this study shows that hypoglycemia in hospitalized patients , whether insulin induced or spontaneous , is associated with increased mortality as compared with absence of hypoglycemia . as expected , insulin - treated patients in our study were more likely to have diabetes and were older than the noninsulin - treated patients . higher mortality in the itc group compared with the ntc group may be due to their older age and higher prevalence of diabetes . however , the presence of hypoglycemia in insulin - treated patients increased their risk of death several - fold compared with itc patients , even though this risk was lower than that in spontaneously hypoglycemic patients . this finding is in contrast to the previous studies that showed that insulin - induced hypoglycemia ( 70 mg / dl ) was not associated with increased risk of mortality ( 1,7 ) . our study is different from previous studies due to a different patient population and inclusion of patients with more severe hypoglycemia . nonetheless , in our study , insulin was highly associated with longer survival and icu admission was highly associated with shorter survival in patients with hypoglycemia . although early trials of tight glycemic control in critically ill hospitalized patients showed benefits of tight glycemic control , subsequent trials either failed to show benefits or ended early due to the risk of hypoglycemia ( 1014 ) . one of the potential explanations for the failure of tight glycemic control has been the high risk of hypoglycemia . most studies , in the inpatient setting as well as in the outpatient setting , have demonstrated that spontaneous hypoglycemia is associated with increased mortality as compared with insulin - induced hypoglycemia , and our study supports these data ( 7,16,17 ) . however , our study also shows that mortality in the ith group was still very high , suggesting only a partial , if any , protective effect of insulin . this was a single - center study , and the sample size for the spontaneous hypoglycemia group was rather small . also , we did not have details about the type of diabetes , duration of diabetes , insulin regimens , or glucose control . we assumed that hypoglycemia in insulin - treated patients was insulin associated even though we did not have information about the exact time of insulin injection and the relation between insulin injection and hypoglycemia . furthermore , our analyses did not include adjustments for several confounders , including serum creatinine , hematocrit , albumin , and the use of other medications , including steroids . however , we did control for comorbidity and the severity of illness by including the cci and admission to the icu . we think these data provide valuable information on the relation between hypoglycemia and mortality in the inpatient setting . we conclude that insulin - induced hypoglycemia as well as spontaneous hypoglycemia is associated with increased mortality among hospitalized patients . prospective studies are needed to determine whether the prevention of hypoglycemia improves outcome in hospitalized patients .
output:
