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Lin J, Zhang J, Liang B, Lin J, Wang N, Lin J, Huang H. Comparison of in-patient glucose team based management with conventional blood glucose management- a retrospective study from China. Diabetol Metab Syndr 2024; 16:2. [PMID: 38172998 PMCID: PMC10763004 DOI: 10.1186/s13098-023-01242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Glycemic control for patients with diabetes in the surgical department is often unsatisfactory. Compounding this issue is the fact that conventional glucose management models are often inefficient and difficult to monitor over time. OBJECTIVE To investigate the impact of inpatient glucose team-based management on glycemic control and hospital days in surgical patients with diabetes. METHODS A retrospective analysis was conducted on 4156 patients with diabetes in the surgical department who received inpatient management of diabetes at a tertiary medical center from June 2020 to May 2022. Based on whether they received inpatient glucose team-based management, the surgical patients with diabetes were divided into two groups: the inpatient glucose team-based management (GM group, consisting of 1698 participants) and the conventional blood glucose management group (control group, consisting of 2458 participants). We compared the two groups in terms of glycemic control, hospital days, and health-care costs. Multiple logistic regression analysis was performed to build the hospital days prediction model and nomogram. Finally, the performance of the model was evaluated. RESULTS The rate of glucose detection was higher in the GM group at 2 h postprandial (P < 0.01). The incidence of hypoglycemia and severe hyperglycemia, blood glucose attainment time, pre-operative preparation days, hospital days, and health-care costs were lower in the GM group than in the control group (P < 0.01). The linear regression model revealed that blood glucose attainment time, incidence of hypoglycemia (< 3.9mmol/L), preoperative preparation days, perioperative complications, and health-care costs were the factors influencing the hospital days (Total Point 83.4 points, mean hospital days 9.37 days). Receiver operating characteristic (ROC) curve analysis demonstrated that the nomogram had good accuracy for predicting hospital days (area under the ROC curve 0.83, 95% confidence interval [CI], 0.74 to 0.92). CONCLUSION Inpatient glucose team-based management demonstrated significant improvements in glycemic control among surgical patients with diabetes, resulting in reduced hospital days and associated costs. The developed nomogram also exhibited promising potential in predicting hospital days, offering valuable clinical applications.
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Affiliation(s)
- Jiayu Lin
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Jinying Zhang
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Bo Liang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Jinkuang Lin
- Department of Medical administration, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Neng Wang
- Department of Information, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Jialin Lin
- Department of Information, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Huibin Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China.
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Jin Z, Zhang K. Association between triglyceride-glucose index and AKI in ICU patients based on MIMICIV database: a cross-sectional study. Ren Fail 2023; 45:2238830. [PMID: 37563796 PMCID: PMC10424620 DOI: 10.1080/0886022x.2023.2238830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/30/2023] [Accepted: 07/15/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Methods for early prediction of the occurrence of acute kidney injury (AKI) were limited. The relationship between triglyceride glucose index (TyG) and the incidence of acute kidney injury in ICU patients is unclear. This study aims to explore the relationship between the two. METHODS Based on their TyG index, participants from the Intensive Care Medical Information Market IV (MIMIC-IV) were divided into quartiles. A logistic regression model was constructed based on the risk of acute kidney injury as the main outcome, in order to detect a potential relationship that may exist between the TyG index and acute kidney injury in ICU patients. Finally, in order to confirm the relationship existing between the TyG index and the results, a restricted cubic spline model was used. RESULTS In total, 54,263 patients were involved in our present study, of whom 48.2% were male. The occurrence of acute kidney injury was 25.1%. An independent relationship was observed between the TyG index and an increased risk of acute kidney injury through multivariate logistic regression analysis (OR, 1.28 [95% CI 1.22-1.35] p < 0.001). Q4 (5.344-9.911) of the TyG index quartiles was independently associated with an increase in the risk of acute kidney injury (OR, 1.43 [95% CI (1.32-1.54)] p < 0.001). Through the restricted cubic spline regression model, the risk of acute kidney injury was also demonstrated to increase linearly with an increase in the TyG index. CONCLUSION The triglyceride glucose index is related to the risk of acute kidney injury in ICU patients. In the future, in order to further validate this finding, larger prospective studies are needed.
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Affiliation(s)
- Zihan Jin
- Tianjin University of Traditional Chinese Medicine, Tianjin, P.R. China
| | - Kai Zhang
- The Second Hospital of Jilin University, Changchun, P.R. China
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3
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Sichieri K, Trevisan DD, Barbosa RL, Secoli SR. Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study. SAO PAULO MED J 2023; 142:e2022666. [PMID: 37531493 PMCID: PMC10393373 DOI: 10.1590/1516-3180.2022.0666.r1.190523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.
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Affiliation(s)
- Karina Sichieri
- Nurse and Doctoral Student, Hospital Universitário (HU),
Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | - Danilo Donizetti Trevisan
- PhD. Nurse and Assistant Professor, Universidade Federal de São
João Del Rei (UFSJ), Divinópolis (MG), Brazil
| | - Ricardo Luís Barbosa
- PhD. Mathematics and Assistant Professor, Universidade Federal
de Uberlândia (UFU), Monte Carmelo (MG), Brazil
| | - Silvia Regina Secoli
- PhD. Nurse and Senior Professor, Graduate Program in Adult
Health Nursing, School of Nursing, Universidade de São Paulo (USP), São Paulo
(SP), Brazil
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Roberts G, Krinsley JS, Preiser JC, Quinn S, Rule PR, Brownlee M, Umpierrez GE, Hirsch IB. Malglycemia in the critical care setting. Part I: Defining hyperglycemia in the critical care setting using the glycemic ratio. J Crit Care 2023; 77:154327. [PMID: 37178493 DOI: 10.1016/j.jcrc.2023.154327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Stress-induced hyperglycemia (SIH) is conventionally represented by Blood Glucose (BG) although recent evidence indicates the Glycemic Ratio (GR, quotient of mean BG and estimated preadmission BG) is a superior prognostic marker. We assessed the association between in-hospital mortality and SIH, using BG and GR in an adult medical-surgical ICU. METHODS We included patients with hemoglobin A1c (HbA1c) and minimum four BGs in a retrospective cohort investigation (n = 4790). RESULTS A critical SIH threshold of GR 1.1 was identified. Mortality increased with increasing exposure to GR ≥ 1.1 (r2 = 0.94, p = 0.0007). Duration of exposure to BG ≥ 180 mg/dL demonstrated a less robust association with mortality (r2 = 0.75, p = 0.059). In risk-adjusted analyses, hours GR ≥ 1.1 (OR 1.0014, 95%CI (1.0003-1.0026), p = 0.0161) and hours BG ≥ 180 mg/dL (OR 1.0080, 95%CI (1.0034-1.0126), p = 0.0006) were associated with mortality. In the cohort with no exposure to hypoglycemia however, only hours GR ≥ 1.1 was associated with mortality (OR 1.0027, 95%CI (1.0012-1.0043), p = 0.0007), not BG ≥ 180 mg/dL (OR 1.0031, 95%CI (0.9949-1.0114), p = 0.50) and this relationship remained intact for those who never experienced BG outside the 70-180 mg/dL range (n = 2494). CONCLUSIONS Clinically significant SIH commenced above GR 1.1. Mortality was associated with hours of exposure to GR ≥ 1.1 which was a superior marker of SIH compared to BG.
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Affiliation(s)
- Greg Roberts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.
| | - James S Krinsley
- Division of Critical Care, Department of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and Surgeons, Stamford, CT, United States of America
| | | | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | - Peter R Rule
- PRI, Los Altos Hills, CA, United States of America
| | - Michael Brownlee
- Diabetes Research Emeritus, Biomedical Sciences Emeritus, Einstein Diabetes Research Center, Department of Medicine and Pathology Emeritus, Albert Einstein College of Medicine, Bronx, NY, United States of America.
| | - Guillermo E Umpierrez
- Division of Metabolism, Endocrinology and Nutrition, University of Washington Medicine Diabetes Institute, Seattle, WA, United States of America.
| | - Irl B Hirsch
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, United States of America.
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Tian Y, Wang R, Zhang M, Li T, He Y, Wang R. Stress-induced Hyperglycemia Ratio as an Independent Risk Factor of In-hospital Mortality in Nonresuscitation Intensive Care Units: A Retrospective Study. Clin Ther 2023; 45:31-39. [PMID: 36621444 DOI: 10.1016/j.clinthera.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/29/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine whether the stress-induced hyperglycemia ratio (SHR) is independently associated with in-hospital mortality in critically ill patients in nonresuscitation ICUs. METHODS In this retrospective cohort study, clinical- and laboratory-related data from patients first admitted to nonresuscitation ICUs were extracted from an open-access database of >50,000 ICU admissions. Patients were assigned to one of two groups according to an SHR threshold of 1.1. The primary end point of this study was the in-hospital mortality rate. The associations between SHR and length of stay in the ICU and hospital, duration of mechanical ventilation use, and vasopressor use were secondary end points. Logistic regression models were established in the analysis of in-hospital mortality risk, and areas under the receiver operating characteristic curve (AUC) were analyzed to investigate the association between the primary end point and SHR used alone or together with the Simplified Acute Physiology Scale (SAPS) II score. The Youden index, specificity, and sensitivity of SHR and SAPS-II were also assessed. FINDINGS In this study, 1859 patients were included, 187 of whom (10.06%) died during hospitalization. The group with an SHR of ≥1.1 had a greater in-hospital mortality rate (13.7% vs 7.4%; P < 0.001), longer length of stay both in the ICU and in the hospital, a longer duration of mechanical ventilation use, and a greater rate of vasopressor use. On adjustment for multivariate risk, a 0.1-point increment in SHR was significantly associated with in-hospital mortality (OR = 1.08; 95% CI, 1.00-1.16; P = 0.036). The AUC of the association between risk and the SAPS-II score was significantly greater than that with SHR (0.797 [95% CI, 0.576-0.664] vs 0.620 [95% CI, 0.764-0.830]; P < 0.001). The AUC with SAPS-II + SHR was significantly greater than that with SAPS-II used alone (0.802 [95% CI, 0.770-0.835] vs 0.797 [95% CI, 0.764-0.830]; P = 0.023). The Youden index, specificity, and sensitivity of SAPS-II + SHR were 0.473, 0.703, and 0.770, respectively. IMPLICATIONS Stress-induced hyperglycemia, as evaluated using the SHR, was associated with increased in-hospital mortality and worse clinical outcomes in these critically ill patients in nonresuscitation ICUs. SHR was an independent risk factor for in-hospital mortality, and when used together with the SAPS-II, added to the capacity to predict mortality in these patients in nonresuscitation ICUs. Prospective data are needed to validate the capacity of SHR in predicting in-hospital mortality in patients in the nonresuscitation ICU.
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Affiliation(s)
- Yiming Tian
- Departments of Endocrinology and Metabolism, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Rui Wang
- Departments of Endocrinology and Metabolism, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Mengmeng Zhang
- Departments of Endocrinology and Metabolism, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Tao Li
- Nephrology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yang He
- Hemodialysis Room, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Rui Wang
- Departments of Endocrinology and Metabolism, First Hospital of Qinhuangdao, Qinhuangdao, China.
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Pichardo-Lowden AR, Haidet P, Umpierrez GE, Lehman EB, Quigley FT, Wang L, Rafferty CM, DeFlitch CJ, Chinchilli VM. Clinical Decision Support for Glycemic Management Reduces Hospital Length of Stay. Diabetes Care 2022; 45:2526-2534. [PMID: 36084251 PMCID: PMC9679255 DOI: 10.2337/dc21-0829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/14/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Dysglycemia influences hospital outcomes and resource utilization. Clinical decision support (CDS) holds promise for optimizing care by overcoming management barriers. This study assessed the impact on hospital length of stay (LOS) of an alert-based CDS tool in the electronic medical record that detected dysglycemia or inappropriate insulin use, coined as gaps in care (GIC). RESEARCH DESIGN AND METHODS Using a 12-month interrupted time series among hospitalized persons aged ≥18 years, our CDS tool identified GIC and, when active, provided recommendations. We compared LOS during 6-month-long active and inactive periods using linear models for repeated measures, multiple comparison adjustment, and mediation analysis. RESULTS Among 4,788 admissions with GIC, average LOS was shorter during the tool's active periods. LOS reductions occurred for all admissions with GIC (-5.7 h, P = 0.057), diabetes and hyperglycemia (-6.4 h, P = 0.054), stress hyperglycemia (-31.0 h, P = 0.054), patients admitted to medical services (-8.4 h, P = 0.039), and recurrent hypoglycemia (-29.1 h, P = 0.074). Subgroup analysis showed significantly shorter LOS in recurrent hypoglycemia with three events (-82.3 h, P = 0.006) and nonsignificant in two (-5.2 h, P = 0.655) and four or more (-14.8 h, P = 0.746). Among 22,395 admissions with GIC (4,788, 21%) and without GIC (17,607, 79%), LOS reduction during the active period was 1.8 h (P = 0.053). When recommendations were provided, the active tool indirectly and significantly contributed to shortening LOS through its influence on GIC events during admissions with at least one GIC (P = 0.027), diabetes and hyperglycemia (P = 0.028), and medical services (P = 0.019). CONCLUSIONS Use of the alert-based CDS tool to address inpatient management of dysglycemia contributed to reducing LOS, which may reduce costs and improve patient well-being.
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Affiliation(s)
- Ariana R. Pichardo-Lowden
- Department of Medicine, Penn State Health, Penn State College of Medicine, Hershey Medical Center, Hershey, PA
| | - Paul Haidet
- Department of Medicine, Penn State Health, Penn State College of Medicine, Hershey Medical Center, Hershey, PA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
- Department of Humanities and the Woodward Center for Excellence in Health Sciences Education, Penn State College of Medicine, Hershey, PA
| | | | - Erik B. Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Francis T. Quigley
- Department of Medicine, Penn State Health St. Joseph Medical Center, Reading, PA
| | - Li Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Colleen M. Rafferty
- Department of Medicine, Penn State Health, Penn State College of Medicine, Hershey Medical Center, Hershey, PA
| | - Christopher J. DeFlitch
- Department of Emergency Medicine, Office of the Chief Medical Information Officer, Penn State Health, Hershey, PA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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Yahia A, Szlávecz Á, Knopp JL, Norfiza Abdul Razak N, Abu Samah A, Shaw G, Chase JG, Benyo B. Estimating Enhanced Endogenous Glucose Production in Intensive Care Unit Patients with Severe Insulin Resistance. J Diabetes Sci Technol 2022; 16:1208-1219. [PMID: 34078114 PMCID: PMC9445352 DOI: 10.1177/19322968211018260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Critically ill ICU patients frequently experience acute insulin resistance and increased endogenous glucose production, manifesting as stress-induced hyperglycemia and hyperinsulinemia. STAR (Stochastic TARgeted) is a glycemic control protocol, which directly manages inter- and intra- patient variability using model-based insulin sensitivity (SI). The model behind STAR assumes a population constant for endogenous glucose production (EGP), which is not otherwise identifiable. OBJECTIVE This study analyses the effect of estimating EGP for ICU patients with very low SI (severe insulin resistance) and its impact on identified, model-based insulin sensitivity identification, modeling accuracy, and model-based glycemic clinical control. METHODS Using clinical data from 717 STAR patients in 3 independent cohorts (Hungary, New Zealand, and Malaysia), insulin sensitivity, time of insulin resistance, and EGP values are analyzed. A method is presented to estimate EGP in the presence of non-physiologically low SI. Performance is assessed via model accuracy. RESULTS Results show 22%-62% of patients experience 1+ episodes of severe insulin resistance, representing 0.87%-9.00% of hours. Episodes primarily occur in the first 24 h, matching clinical expectations. The Malaysian cohort is most affected. In this subset of hours, constant model-based EGP values can bias identified SI and increase blood glucose (BG) fitting error. Using the EGP estimation method presented in these constrained hours significantly reduced BG fitting errors. CONCLUSIONS Patients early in ICU stay may have significantly increased EGP. Increasing modeled EGP in model-based glycemic control can improve control accuracy in these hours. The results provide new insight into the frequency and level of significantly increased EGP in critical illness.
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Affiliation(s)
- Anane Yahia
- Department of Control Engineering and Information Technology, Budapest University of Technology and Economics, Budapest, Hungary
- Anane Yahia, Department of Control Engineering and Information Technology, Budapest University of Technology and Economics, 2. Magyar tudosok Blvd., Budapest, H-1117, Hungary.
| | - Ákos Szlávecz
- Department of Control Engineering and Information Technology, Budapest University of Technology and Economics, Budapest, Hungary
| | - Jennifer L. Knopp
- Mechanical Engineering, Centre of Bio-Engineering, University of Canterbury, Christchurch, NZ
| | | | - Asma Abu Samah
- Institute of Energy Infrastructure, Universiti Tenaga Nasional, Jalan Ikram-UNITEN, Kajang, Selangor, Malaysia
| | - Geoff Shaw
- Mechanical Engineering, Centre of Bio-Engineering, University of Canterbury, Christchurch, NZ
| | - J. Geoffrey Chase
- Mechanical Engineering, Centre of Bio-Engineering, University of Canterbury, Christchurch, NZ
| | - Balazs Benyo
- Department of Control Engineering and Information Technology, Budapest University of Technology and Economics, Budapest, Hungary
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8
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Le VT, Ha QH, Tran MT, Le NT, Le VT, Le MK. Hyperglycemia in Severe and Critical COVID-19 Patients: Risk Factors and Outcomes. Cureus 2022; 14:e27611. [PMID: 35949446 PMCID: PMC9356651 DOI: 10.7759/cureus.27611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Hyperglycemia is commonly seen in critically ill patients. This disorder was also seen in coronavirus disease 2019 (COVID-19) patients and was associated with a worse prognosis. The current study determined the prevalence, risk factors, and prognostic implications of hyperglycemia in COVID-19 patients. Method: This was a retrospective observational study performed in an intensive care unit for COVID-19 patients. Electronic data of COVID-19 patients admitted to the intensive care unit from August 2nd to October 15th, 2021, were collected. Patients were divided into non-hyperglycemia, hyperglycemia in diabetic patients, and hyperglycemia in non-diabetic patients. Primary outcomes were 28-day and in-hospital mortalities. Multinomial logistic regression and multivariable Cox regression models were used to determine the risk factors for hyperglycemia and mortality, respectively. Results: Hyperglycemia was documented in 65.6% of patients: diabetic patients (44.8%) and new-onset hyperglycemia (20.8%). In-hospital and 28-day mortality rates were 30.2% and 26.1%, respectively. Respiratory failure, corticosteroid therapy, and a higher level of procalcitonin were risk factors for hyperglycemia in diabetic patients, whereas cardiovascular diseases, respiratory failure, and higher aspartate aminotransferase/glutamate aminotransferase ratio were risk factors for hyperglycemia in non-diabetic patients. The risk of the 28-day mortality rate was highest in the new-onset hyperglycemia (hazard ratio [HR] 3.535, 95% confidence interval [CI] 1.338-9.338, p=0.011), which was higher than hyperglycemia in type 2 diabetes mellitus patients (HR 1.408, 95% CI 0.513-3.862, p=0.506). Conclusion: Hyperglycemia was common in COVID-19 patients in the intensive care unit. Hyperglycemia reflected the disease severity but was also secondary to therapeutic intervention. New-onset hyperglycemia was associated with poorer outcomes than that in diabetic patients.
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9
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Joshi A, Mehta Y. Dysglycemia in ICU Patients. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1750116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractDysglycemia has emerged as a very common challenge in critically ill patients, especially with regard to current coronavirus disease 2019 pandemic. Prediabetes, poorly controlled diabetes, pharmaceutical intervention in intensive care unit (ICU) with glucocorticoids, catecholamines and other medicines, and stress response all contribute to dysglycemia in critically ill patients. Early identification and management are the key to prevent further complications. Patient prognosis in terms of clinical outcome, length of ICU stay, and in-hospital morbidity/mortality are adversely affected by patient's dysglycemic status. Apart from hyperglycemia, the other three important pillars of dysglycemia are discussed in this article. Synopsis of early intervention have been captured from India-specific practice guidelines. Important landmark trials have also been captured in this article to provide a clarity on certain aspects of managing dysglycemia in ICUs. Hence, this review article is an attempt to bring forth the salient aspects in diagnosing and managing dysglycemia in critical care settings.
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Affiliation(s)
- Anshu Joshi
- Anaesthesiology and Critical Care, Medanta – The Medicity, Sect 38, Gurgaon, Haryana, India
| | - Yatin Mehta
- Anaesthesiology and Critical Care, Medanta – The Medicity, Sect 38, Gurgaon, Haryana, India
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10
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Jenssen C, Pietsch C. Stationäre Patienten mit der Nebendiagnose Diabetes mellitus: klinische Relevanz. DIABETOLOGE 2022. [PMCID: PMC9045025 DOI: 10.1007/s11428-022-00897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In deutschen Krankenhäusern werden jährlich etwa 3 Mio. Patienten mit Diabetes stationär behandelt, davon 93 % nicht wegen, sondern mit dieser Erkrankung. In einzelnen Fachabteilungen liegt bei bis zu 40 % der Patienten die Nebendiagnose Diabetes vor. Sie haben oft eine relevante Komorbidität und im Vergleich zu Krankenhauspatienten ohne Diabetes eine längere stationäre Verweildauer, entwickeln deutlich häufiger Komplikationen und müssen öfter kurzfristig wieder aufgenommen werden. In dieser Übersicht wird die klinische Relevanz der Nebendiagnose Diabetes mellitus für Krankenhauspatienten besprochen.
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Affiliation(s)
- Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland GmbH, 15344 Strausberg, Deutschland
| | - Cristine Pietsch
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland GmbH, 15344 Strausberg, Deutschland
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11
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Khunti K, Del Prato S, Mathieu C, Kahn SE, Gabbay RA, Buse JB. COVID-19, Hyperglycemia, and New-Onset Diabetes. Diabetes Care 2021; 44:2645-2655. [PMID: 34625431 PMCID: PMC8669536 DOI: 10.2337/dc21-1318] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/03/2021] [Indexed: 02/03/2023]
Abstract
Certain chronic comorbidities, including diabetes, are highly prevalent in people with coronavirus disease 2019 (COVID-19) and are associated with an increased risk of severe COVID-19 and mortality. Mild glucose elevations are also common in COVID-19 patients and associated with worse outcomes even in people without diabetes. Several studies have recently reported new-onset diabetes associated with COVID-19. The phenomenon of new-onset diabetes following admission to the hospital has been observed previously with other viral infections and acute illnesses. The precise mechanisms for new-onset diabetes in people with COVID-19 are not known, but it is likely that a number of complex interrelated processes are involved, including previously undiagnosed diabetes, stress hyperglycemia, steroid-induced hyperglycemia, and direct or indirect effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the β-cell. There is an urgent need for research to help guide management pathways for these patients. In view of increased mortality in people with new-onset diabetes, hospital protocols should include efforts to recognize and manage acute hyperglycemia, including diabetic ketoacidosis, in people admitted to the hospital. Whether new-onset diabetes is likely to remain permanent is not known, as the long-term follow-up of these patients is limited. Prospective studies of metabolism in the setting of postacute COVID-19 will be required to understand the etiology, prognosis, and treatment opportunities.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, U.K.
| | - Stefano Del Prato
- Section of Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chantal Mathieu
- Laboratory for Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Steven E Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
| | - Robert A Gabbay
- Harvard Medical School, Boston, MA
- American Diabetes Association, Arlington, VA
| | - John B Buse
- Division of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC
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12
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El-Menyar A, Asim M, Mir F, Hakim S, Kanbar A, Siddiqui T, Younis B, Ahmed K, Mahmood I, Atique S, Al Jogol H, Taha I, Mustafa F, Alabdallat M, Abdelrahman H, Peralta R, Al-Thani H. Patterns and Effects of Admission Hyperglycemia and Inflammatory Response in Trauma Patients: A Prospective Clinical Study. World J Surg 2021; 45:2670-2681. [PMID: 34117510 PMCID: PMC8321976 DOI: 10.1007/s00268-021-06190-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients. METHODS A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6, IL-18 and hs-CRP. Patients were categorized into four groups [non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)]. The inflammatory markers were measured on three time points (admission, 24 h and 48 h). Generalized estimating equations (GEE) were used to account for the correlation for the inflammatory markers. Pearson's correlation test and logistic regression analysis were also performed. RESULTS During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (50% had SIH and 50% had DH). Patients with SIH were younger, had significantly higher Injury Severity Score (ISS), higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p = 0.005), lower Trauma Injury Severity Score (p = 0.01) and lower GCS (p = 0.001). Patients with hyperglycemia had higher in-hospital mortality than the normoglycemia group (12.5% vs 3.7%; p = 0.02). A significant correlation was identified between the initial blood glucose level and serum lactate, IL-6, ISS and hospital length of stay. Overall rate of change in slope 88.54 (95% CI:-143.39-33.68) points was found more in hyperglycemia than normoglycemia group (p = 0.002) for IL-6 values, whereas there was no statistical significant change in slopes of age, gender and their interaction. The initial IL-6 levels correlated with ISS (r = 0.40, p = 0.001). On-admission hyperglycemia had an adjusted odds ratio 2.42 (95% CI: 1.076-5.447, p = 0.03) for severe injury (ISS > 12) after adjusting for age, shock index and blood transfusion. CONCLUSIONS In trauma patients, on-admission hyperglycemia correlates well with the initial serum IL-6 level and is associated with more severe injuries. Therefore, it could be a simple marker of injury severity and useful tool for patient triage and risk assessment. TRIAL REGISTRATION This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016. https://clinicaltrials.gov/ct2/show/NCT02999386 .
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Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
- Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
| | - Mohammad Asim
- Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Fayaz Mir
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Suhail Hakim
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Tariq Siddiqui
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Basil Younis
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ismail Mahmood
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Sajid Atique
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hisham Al Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ibrahim Taha
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Fuad Mustafa
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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13
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Moyer ED, Lehman EB, Bolton MD, Goldstein J, Pichardo-Lowden AR. Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care. Sci Rep 2021; 11:11476. [PMID: 34075071 PMCID: PMC8169760 DOI: 10.1038/s41598-021-89945-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/21/2021] [Indexed: 12/15/2022] Open
Abstract
Stress hyperglycemia (SH) is a manifestation of altered glucose metabolism in acutely ill patients which worsens outcomes and may represent a risk factor for diabetes. Continuity of care can assess this risk, which depends on quality of hospital clinical documentation. We aimed to determine the incidence of SH and documentation tendencies in hospital discharge summaries and continuity notes. We retrospectively examined diagnoses during a 12-months period. A 3-months representative sample of discharge summaries and continuity clinic notes underwent manual abstraction. Over 12-months, 495 admissions had ≥ 2 blood glucose measurements ≥ 10 mmol/L (180 mg/dL), which provided a SH incidence of 3.3%. Considering other glucose states suggestive of SH, records showing ≥ 4 blood glucose measurements ≥ 7.8 mmol/L (140 mg/dL) totaled 521 admissions. The entire 3-months subset of 124 records lacked the diagnosis SH documentation in discharge summaries. Only two (1.6%) records documented SH in the narrative of hospital summaries. Documentation or assessment of SH was absent in all ambulatory continuity notes. Lack of documentation of SH contributes to lack of follow-up after discharge, representing a disruptor of optimal care. Activities focused on improving quality of hospital documentation need to be integral to the education and competency of providers within accountable health systems.
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Affiliation(s)
- Eric D Moyer
- Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Suite 3400, Hershey, PA, 17033, USA
| | - Matthew D Bolton
- Information Services, Penn State Health and Penn State College of Medicine, Room 3315, 100 Crystal A Drive, Hershey, PA, 17033, USA
| | - Jennifer Goldstein
- Department of Medicine, Milton S. Hershey Medical Center, Penn State Health, Penn State College of Medicine, Penn State University, 500 University Drive, Hershey, PA, 17033, USA
| | - Ariana R Pichardo-Lowden
- Department of Medicine, Milton S. Hershey Medical Center, Penn State Health, Penn State College of Medicine, Penn State University, 500 University Drive, Hershey, PA, 17033, USA.
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14
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Lazzeri C, Bonizzoli M, Batacchi S, Di Valvasone S, Chiostri M, Peris A. The prognostic role of hyperglycemia and glucose variability in covid-related acute respiratory distress Syndrome. Diabetes Res Clin Pract 2021; 175:108789. [PMID: 33812902 PMCID: PMC8015370 DOI: 10.1016/j.diabres.2021.108789] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/07/2021] [Accepted: 03/27/2021] [Indexed: 01/08/2023]
Abstract
AIMS Due to heterogeneity on the prognostic role of glucose values and glucose variability in Novel Coronavirus (COVID) disease, we aimed at assessing the prognostic role for Intensive Care Unit (ICU) death of admission hyperglycaemia, peak glycemia and glucose variability in critically ill COVID patients: METHODS: 83 patients consecutively admitted for COVID-related Acute Respiratory Distress Syndrome (ARDS) from from 1st March to 1st October 2020. RESULTS Non survivors were older, with more comorbidities and a more severe disease. Corticosteroids were used in the majority of patients (54/83, 65%) with no difference between survivors and non survivors. Mean blood glucose values, (during the first 24 and 48 h, respectively), were comparable between the two subgroups, as well as SD 24 and CV 24. During the first 48 h, survivors showed significantly lower values of SD 48 (p < 0.001) and CV 48, respectively (p < 0.001) than non survivors. CONCLUSIONS in consecutive COVID-related ARDS patients admitted to ICU hyperglycemia (>180 mg/dl) is more common in non survivors who also showed a significantly higher glucose variability in the first 48 h since ICU admission. Our findings point to the clinical significance of in-ICU glucose control in severe COVID patients.
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Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stafano Batacchi
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simona Di Valvasone
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Chiostri
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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15
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Emidio AC, Faria R, Bispo B, Vaz-Pinto V, Messias A, Meneses-Oliveira C. GlucoSTRESS - A project to optimize glycemic control in a level C (III) Portuguese intensive care unit. Rev Bras Ter Intensiva 2021; 33:138-145. [PMID: 33886863 PMCID: PMC8075347 DOI: 10.5935/0103-507x.20210015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 06/17/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To double the percentage of time within the 100 - 180mg/dL blood glucose range in the first three months following a phased implementation of a formal education program, and then, of an insulin therapy protocol, without entailing an increased incidence of hypoglycemia. Methods The pre-intervention glycemic control was assessed retrospectively. Next, were carried out the implementation of a formal education program, distribution of manual algorithms for intravenous insulin therapy - optimized by the users, based on the modified Yale protocol - and informal training of the nursing staff. The use of electronic blood glucose control systems was supported, and the results were recorded prospectively. Results The first phase of the program (formal education) lead to improvement of the time within the euglycemic interval (28% to 37%). In the second phase, euglycemia was achieved 66% of the time, and the incidence of hypoglycemia was decreased. The percentage of patients on intravenous insulin infusion at 48 hours from admission increased from 6% to 35%. Conclusion The phased implementation of a formal education program, fostering the use of electronic insulin therapy protocols and dynamic manuals, received good adherence and has shown to be safe and effective for blood glucose control in critically ill patients, with a concomitant decrease in hypoglycemia.
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Affiliation(s)
- Ana Catarina Emidio
- Serviço de Medicina Interna, Centro Hospitalar de Setúbal - Setúbal, Portugal
| | - Rita Faria
- Serviço de Medicina Intensiva, Hospital Beatriz Ângelo - Loures, Lisboa, Portugal
| | - Bruno Bispo
- Serviço de Medicina Intensiva, Hospital Beatriz Ângelo - Loures, Lisboa, Portugal
| | - Vítor Vaz-Pinto
- Serviço de Medicina Intensiva, Hospital Beatriz Ângelo - Loures, Lisboa, Portugal
| | - António Messias
- Serviço de Medicina Intensiva, Hospital Beatriz Ângelo - Loures, Lisboa, Portugal
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16
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Corrao S, Pinelli K, Vacca M, Raspanti M, Argano C. Type 2 Diabetes Mellitus and COVID-19: A Narrative Review. Front Endocrinol (Lausanne) 2021; 12:609470. [PMID: 33868163 PMCID: PMC8044543 DOI: 10.3389/fendo.2021.609470] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
The pandemic of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has involved more than one hundred million individuals, including more than two million deaths. Diabetes represents one of the most prevalent chronic conditions worldwide and significantly increases the risk of hospitalization and death in COVID-19 patients. In this review, we discuss the prevalence, the pathophysiological mechanisms, and the outcomes of COVID-19 infection in people with diabetes. We propose a rationale for using drugs prescribed in patients with diabetes and some pragmatic clinical recommendations to deal with COVID-19 in this kind of patient.
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Affiliation(s)
- Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro", PROMISE, University of Palermo, Palermo, Italy
| | - Karen Pinelli
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Martina Vacca
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Massimo Raspanti
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Christiano Argano
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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17
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Mamtani M, Athavale AM, Abraham M, Vernik J, Amarah AR, Ruiz JP, Joshi AJ, Itteera M, Zhukovski SD, Madaiah RP, White BC, Hart P, Kulkarni H. Association of hyperglycaemia with hospital mortality in nondiabetic COVID-19 patients: A cohort study. DIABETES & METABOLISM 2021; 47:101254. [PMID: 33781926 PMCID: PMC7994287 DOI: 10.1016/j.diabet.2021.101254] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 01/08/2023]
Abstract
Objective Diabetes is a known risk factor for mortality in Coronavirus disease 2019 (COVID-19) patients. Our objective was to identify prevalence of hyperglycaemia in COVID-19 patients with and without prior diabetes and quantify its association with COVID-19 disease course. Research design and methods This observational cohort study included all consecutive COVID-19 patients admitted to John H Stroger Jr. Hospital, Chicago, IL from March 15, 2020 to May 3, 2020 and followed till May 15, 2020. The primary outcome was hospital mortality, and the studied predictor was hyperglycaemia [any blood glucose ≥7.78 mmol/L (140 mg/dL) during hospitalization]. Results Of the 403 COVID-19 patients studied, 51 (12.7%) died; 335 (83.1%) were discharged while 17 (4%) were still in hospital. Hyperglycaemia occurred in 228 (56.6%) patients; 83 of these hyperglycaemic patients (36.4%) had no prior history of diabetes. Compared to the reference group no-diabetes/no-hyperglycaemia patients the no-diabetes/hyperglycaemia patients showed higher mortality [1.8% versus 20.5%, adjusted odds ratio 21.94 (95% confidence interval 4.04–119.0), P < 0.001]; improved prediction of death (P = 0.01) and faster progression to death (P < 0.01). Hyperglycaemia within the first 24 and 48 h was also significantly associated with mortality (odds ratio 2.15 and 3.31, respectively). Conclusions Hyperglycaemia without prior diabetes was common (20.6% of hospitalized COVID-19 patients) and was associated with an increased risk of and faster progression to death. Development of hyperglycaemia in COVID-19 patients who do not have diabetes is an early indicator of progressive disease.
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Affiliation(s)
- M Mamtani
- M&H Research, LLC, San Antonio, Texas, USA
| | - A M Athavale
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - M Abraham
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - J Vernik
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - A R Amarah
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - J P Ruiz
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - A J Joshi
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - M Itteera
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | | | - R P Madaiah
- Cerner Corporation, Kansas City, Missouri, USA
| | - B C White
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - P Hart
- Division of Nephrology, Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - H Kulkarni
- M&H Research, LLC, San Antonio, Texas, USA.
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18
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Furlan JC. Effects on Outcomes of Hyperglycemia in the Hyperacute Stage after Acute Traumatic Spinal Cord Injury. Neurotrauma Rep 2021; 2:14-24. [PMID: 34223544 PMCID: PMC8240828 DOI: 10.1089/neur.2020.0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hyperglycemia has adverse effects on neuronal recovery after brain injury, but its effects after spinal cord injury (SCI) are understudied. This retrospective cohort study examined the potential effects on outcomes of hyperglycemia in the hyperacute stage after acute traumatic SCI. This study included all individuals enrolled in the National Acute Spinal Cord Injury Study 3 (NASCIS-3). Glycemic levels at 24 h, at 48 h, and at day 7 after acute SCI were examined as potential determinants of survival, neurological outcomes (using NASCIS motor, sensory, and pain scores), and functional outcome (using the Functional Independence Measure [FIM]) within the first year post-SCI. Hyperglycemia was defined using two thresholds (140 mg/dL and 180 mg/dL). Study subjects were 76 females and 423 males with an overall mean age of 36 years who sustained mostly cervical SCI due to motor vehicle accidents or falls. Hyperglycemia diagnosed at day 7 post-injury was associated with significantly greater mortality rates post-SCI. Among the survivors, hyperglycemia during the hyperacute stage was not significantly correlated with neurological recovery post-SCI. Hyperglycemia persistent until day 7 was significantly correlated with lower functional scores post-SCI. These results suggest that hyperglycemia at day 7 is correlated with greater mortality rates within the first year post-SCI. Although hyperglycemia during the hyperacute stage was not associated with neurological recovery, hyperglycemia at day 7 may adversely affect functional recovery within the first year post-SCI. Future investigations are needed to determine the optimal glycemic target in the management of patients with SCI.
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Affiliation(s)
- Julio C. Furlan
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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19
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Rajpal A, Rahimi L, Ismail‐Beigi F. Factors leading to high morbidity and mortality of COVID-19 in patients with type 2 diabetes. J Diabetes 2020; 12:895-908. [PMID: 32671936 PMCID: PMC7405270 DOI: 10.1111/1753-0407.13085] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a recent pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus. Diabetes (mostly type 2 diabetes mellitus, T2DM) and hyperglycemia are among the major comorbidities in patients with COVID-19 leading to poor outcomes. Reports show that patients with diabetes and COVID-19 are at an increased risk for developing severe complications including acute respiratory distress syndrome, multi-organ failure, and death. Here we explore potential mechanistic links that could explain the observed higher morbidity and mortality in this patient population. Patients with T2DM have an underlying increased level of inflammation associated with obesity and insulin resistance in addition to other comorbidities including hypertension, obesity, cardiovascular disease, dyslipidemia, and being older. We review evidence that T2DM with hyperglycemia are among factors that lead to elevated expression of angiotensin-converting enzyme 2 (ACE2) in lungs and other tissues; ACE2 is the cellular "receptor" and port of viral entry. The preexisting chronic inflammation with augmented inflammatory response to the infection and the increasing viral load leads to extreme systemic immune response ("cytokine storm") that is strongly associated with increased severity of COVID-19. Based on the available evidence, it is recommended by a panel of experts that safe but stringent control of blood glucose, blood pressure, and lipids be carried out in patients with T2DM, measures that could potentially serve to decrease the severity of COVID-19 should these patients contract the viral infection. Once the infection occurs, then attention should be directed to proper glycemic control with use of insulin and frequent monitoring of blood glucose levels.
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Affiliation(s)
- Aman Rajpal
- Department of MedicineCase Western Reserve University and Cleveland VA Medical CenterClevelandOhioUSA
| | - Leili Rahimi
- Department of MedicineCase Western Reserve University and University Hospitals Cleveland Medical CenterClevelandOhioUSA
| | - Faramarz Ismail‐Beigi
- Department of MedicineCase Western Reserve University and Cleveland VA Medical CenterClevelandOhioUSA
- Department of MedicineCase Western Reserve University and University Hospitals Cleveland Medical CenterClevelandOhioUSA
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20
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Koraćević G, Mićić S, Stojanović M, Tomašević M, Kostić T, Koraćević M, Janković I. Single prognostic cut-off value for admission glycemia in acute myocardial infarction has been used although high-risk stems from hyperglycemia as well as from hypoglycemia (a narrative review). Prim Care Diabetes 2020; 14:594-604. [PMID: 32988774 DOI: 10.1016/j.pcd.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/30/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023]
Abstract
All original articles and meta-analysis use the single cut-off value to distinguish high-risk hyperglycemic from other acute myocardial infarction (AMI) patients. The mortality rate is 3.9 times higher in non-diabetic AMI patients with admission glycemia ≥6.1mmol compared to normoglycemic non-diabetic AMI patients. On the other hand, admission hypoglycemia in AMI is an important predictor of mortality. Because both admission hypo- and hyperglycemia correspond to higher in-hospital mortality, this graph is recognized as "J or U shaped curve". The review suggests two cut-off values for admission glycemia for risk assessment in AMI instead of single one because hypoglycemia as well as hyperglycemia represents a high-risk factor.
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Affiliation(s)
- Goran Koraćević
- Department for Cardiovascular Diseases, Clinical Center Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | | | | | - Miloje Tomašević
- Faculty of Medicine, University of Belgrade, Department of Cardiology, Clinical Center Serbia, Belgrade, Serbia
| | - Tomislav Kostić
- Department for Cardiovascular Diseases, Clinical Center Niš, Serbia; Faculty of Medicine, University of Niš, Serbia
| | - Maja Koraćević
- Faculty of Medicine, University of Niš, Serbia; Innovation Center, University of Niš, Serbia
| | - Irena Janković
- Faculty of Medicine, University of Niš, Serbia; Clinic of Plastic and Reconstructive Surgery, Clinical Center Niš, Serbia
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21
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Singh AK, Singh R. Does poor glucose control increase the severity and mortality in patients with diabetes and COVID-19? Diabetes Metab Syndr 2020; 14:725-727. [PMID: 32473903 PMCID: PMC7251348 DOI: 10.1016/j.dsx.2020.05.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Diabetes in often associated with an increased severity and mortality in patients with COVID-19. We aimed to find out whether the severity and mortality in patients with diabetes with COVID-19 has any correlation to the level of glycemic control. METHODS A Boolean search was made in PubMed database using the specific keywords related to our objectives up till May 14, 2020 and full text of article retrieved with the supplements published in English language. RESULTS Two studies available so far have studied the outcomes of severity and mortality in patients with diabetes stratified on glycemic control. Both the studies have unequivocally found that patients with poorly-controlled hyperglycemia (blood glucose >180 mg/dl) have significantly higher level of poor prognostic markers biochemically, compared to the well-controlled arms (blood glucose <180 mg/dl). Moreover, significant increase in severity and mortality was observed in cohorts with poorly-controlled blood glucose due to any cause (diabetes or stress hyperglycemia), compared to the well-controlled cohorts with COVID-19, even after the adjustment of multiple confounders. CONCLUSIONS Poorly-controlled hyperglycemia increases the severity and mortality in patients with COVID-19. All treating physician must strive for a good glycemic control (blood glucose <180 mg/dl) in patients with or without diabetes.
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Affiliation(s)
| | - Ritu Singh
- G.D Hospital & Diabetes Institute, Kolkata, India
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22
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Relative Hyperglycemia Is an Independent Determinant of In-Hospital Mortality in Patients With Critical Illness. Crit Care Med 2020; 48:e115-e122. [PMID: 31939810 DOI: 10.1097/ccm.0000000000004133] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine whether relative hyperglycemia was associated with in-hospital mortality in critically ill patients independent of other prognostic variables and whether this association is affected by background glycemia. DESIGN Prospective observational study. SETTING Mixed medical-surgical ICU in a metropolitan teaching hospital. PATIENTS From 2,617 admissions to ICU between January 27, 2016, and March 30, 2017, 1,262 consecutive patients who met inclusion and exclusion criteria were studied. INTERVENTIONS Glycosylated hemoglobin was used to estimate average glucose concentration over the prior 3 months. Glucose concentration on ICU admission was divided by estimated average glucose concentration to calculate the stress hyperglycemia ratio, an index of relative glycemia. Risk of death score was calculated using data submitted to the Australia and New Zealand Intensive Care Society. MEASUREMENTS AND MAIN RESULTS In this study, there were 186 deaths (14.7%). Admission glucose was significantly associated with mortality in univariate analysis (odds ratio = 1.08 per mmol/L glucose increment; p < 0.001) but not after adjustment for risk of death score (odds ratio = 1.01; p = 0.338). In contrast, stress hyperglycemia ratio was significantly associated with mortality both in univariate analysis (odds ratio = 1.09 per 0.1 stress hyperglycemia ratio increment; p < 0.001) and after adjustment for risk of death score (odds ratio = 1.03; p = 0.014). Unlike admission glucose concentration, stress hyperglycemia ratio was significantly associated with mortality in patients with glycosylated hemoglobin less than 6.5% (odds ratio = 1.08 per 0.1 stress hyperglycemia ratio increment; p < 0.001) and glycosylated hemoglobin greater than or equal to 6.5% (48 mmol/mol) (odds ratio = 1.08 per 0.1 stress hyperglycemia ratio increment; p = 0.005). CONCLUSIONS Unlike absolute hyperglycemia, relative hyperglycemia, as assessed by the stress hyperglycemia ratio, independently predicts in-hospital mortality in critically ill patients across the glycemic spectrum. Future studies should investigate whether using measures of relative hyperglycemia to determine individualized glycemic treatment targets improves outcomes in ICU.
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Lazzeri C, Bonizzoli M, Cianchi G, Ciapetti M, Socci F, Peris A. The prognostic role of peak glycemia and glucose variability in trauma: a single-center investigation. Acta Diabetol 2020; 57:931-935. [PMID: 32125532 DOI: 10.1007/s00592-020-01493-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/28/2020] [Indexed: 12/22/2022]
Abstract
AIM Admission hyperglycemia and glucose variability were associated with mortality in critically ill patients, but data on trauma patients are to date scarce and heterogeneous. METHODS We assessed the prognostic role of ICU death of admission and peak glycemia and glucose variability (indicated by the standard deviation of mean glucose levels and the coefficient of variation of glucose) in 252 patients consecutively admitted for trauma in our ICU (January 1, 2016-December 31, 2018). RESULTS The in-ICU mortality rate was 17% (43/252). When compared to patients who died during ICU stay, survivors were younger (p = 0.001), more frequently males (p = 0.002), with a lower incidence of hypertension (p = 0.023). Higher values of SAPS II, SOFA and ISS were observed in nonsurvivors (p < 0.001, p < 0.001, p < 0.001, respectively). Survivors exhibited significantly lower values of admission glycemia (p = 0.001), peak glycemia (p = 0.002) and mean glucose values measured during the first 24 h since ICU admission (p = 0.001). Glucose variability was significantly higher in nonsurvivors, as indicated by higher values of SD and CV (p = 0.001 and p = 0.001, respectively). At multivariate regression analysis, admission glycemia (Model 1), peak glycemia (Model 2) and glucose variability (Model 3 and 4) were independent predictors for in-ICU mortality. CONCLUSIONS Our findings indicate that not only admission glycemia but also peak glycemia and glucose variability show a correlation with in-ICU mortality in trauma patients.
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Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy.
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Giovanni Cianchi
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Marco Ciapetti
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Filippo Socci
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 1, 50134, Florence, Italy
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Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, Klonoff DC. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol 2020; 14:813-821. [PMID: 32389027 PMCID: PMC7673150 DOI: 10.1177/1932296820924469] [Citation(s) in RCA: 442] [Impact Index Per Article: 110.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Diabetes has emerged as an important risk factor for severe illness and death from COVID-19. There is a paucity of information on glycemic control among hospitalized COVID-19 patients with diabetes and acute hyperglycemia. METHODS This retrospective observational study of laboratory-confirmed COVID-19 adults evaluated glycemic and clinical outcomes in patients with and without diabetes and/or acutely uncontrolled hyperglycemia hospitalized March 1 to April 6, 2020. Diabetes was defined as A1C ≥6.5%. Uncontrolled hyperglycemia was defined as ≥2 blood glucoses (BGs) > 180 mg/dL within any 24-hour period. Data were abstracted from Glytec's data warehouse. RESULTS Among 1122 patients in 88 U.S. hospitals, 451 patients with diabetes and/or uncontrolled hyperglycemia spent 37.8% of patient days having a mean BG > 180 mg/dL. Among 570 patients who died or were discharged, the mortality rate was 28.8% in 184 diabetes and/or uncontrolled hyperglycemia patients, compared with 6.2% of 386 patients without diabetes or hyperglycemia (P < .001). Among the 184 patients with diabetes and/or hyperglycemia who died or were discharged, 40 of 96 uncontrolled hyperglycemia patients (41.7%) died compared with 13 of 88 patients with diabetes (14.8%, P < .001). Among 493 discharged survivors, median length of stay (LOS) was longer in 184 patients with diabetes and/or uncontrolled hyperglycemia compared with 386 patients without diabetes or hyperglycemia (5.7 vs 4.3 days, P < .001). CONCLUSION Among hospitalized patients with COVID-19, diabetes and/or uncontrolled hyperglycemia occurred frequently. These COVID-19 patients with diabetes and/or uncontrolled hyperglycemia had a longer LOS and markedly higher mortality than patients without diabetes or uncontrolled hyperglycemia. Patients with uncontrolled hyperglycemia had a particularly high mortality rate. We recommend health systems which ensure that inpatient hyperglycemia is safely and effectively treated.
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Affiliation(s)
| | | | | | | | | | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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Srinath R, Mechanick JI. Dietary management of blood glucose in medical critically ill patients with overweight/obesity. Curr Opin Clin Nutr Metab Care 2020; 23:116-120. [PMID: 32004236 DOI: 10.1097/mco.0000000000000636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW As the obesity epidemic continues, there is a greater proportion of patients with overweight, obesity, and other forms of adiposity-based chronic disease that require intensive care. Nutrition therapy in the ICU is a vital part of critical care but can be challenging in this setting because of the increased risk of stress hyperglycemia and adverse impact of obesity- and diabetes-related complications. RECENT FINDINGS Current guidelines favor early nutritional therapy with a hypocaloric, high-protein diet in patients with overweight/obesity. More aggressive protein intake may be useful in those with greater severity of overweight/obesity with an upper limit of 3 g/kg ideal body weight per day. Although there is no specific recommendation, choosing enteral formulas with higher fat content and slower digesting carbohydrates may assist with glucose control. Supplementation with immunonutrients is recommended, given their known benefits in obesity and in reducing inflammation, but must be done in an individualized manner. SUMMARY Aggressive nutritional therapy is crucial in patients with overweight/obesity to support ongoing metabolic demands. Although a hypocaloric high-protein feeding strategy is a starting point, nutritional therapy should be approached in an individualized manner taking into account age, weight and BMI, basal metabolism, nutrition status, complications, and comorbidities.
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Affiliation(s)
| | - Jeffrey I Mechanick
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Altabas V, Pukec L, Mlinarić S, Pintarić H, Šikić A. Stress Hyperglycaemia Indicates Embolus Size and Localization in Patients with Acute Pulmonary Embolism. Int J Endocrinol 2020; 2020:3606757. [PMID: 32724305 PMCID: PMC7366194 DOI: 10.1155/2020/3606757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Acute pulmonary embolism is a life-threatening form of venous thromboembolism often causing stress hyperglycaemia. The aim of this study was to determine the prognostic value of stress hyperglycaemia in acute pulmonary embolism, providing new insights into the presumed embolus size and localization, clinical parameters (Pulmonary Embolism Severity Index, PESI), and in-hospital mortality. Design and Methods. Among a total of 95,454 patients referred to the Emergency Department of the Sestre Milosrdnice University Hospital Centre between 2014 and 2016, all patients with acute pulmonary embolism were included into this observational cohort study. The study group consisted of 190 patients aged 25-96. Relevant patient history, clinical data, and laboratory findings were collected during the entire hospitalization period. Data were analyzed for the entire group of patients, as well as separately for patients without diabetes, using the Fisher exact test and logistic regression. RESULTS Analysis of embolus localization as an indirect parameter of embolus size showed that patients with stress hyperglycaemia more often had emboli located in proximal parts of the pulmonary circulation (i.e., main artery or lobar branches) (p < 0.05). Furthermore, stress hyperglycaemia correlated with PESI score and diabetes (p < 0.05) in the entire patient group. Stress hyperglycaemia showed independent association with in-hospital mortality in patients (p < 0.05). CONCLUSION Stress hyperglycaemia in patients with acute pulmonary embolism is associated with embolus localization in larger arteries of the pulmonary circulation and higher PESI score and therefore could serve as an independent in-hospital mortality predictor.
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Affiliation(s)
- Velimir Altabas
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Clinic for Internal Medicine, Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Lucija Pukec
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Hrvoje Pintarić
- Emergency Department, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Aljoša Šikić
- Emergency Department, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
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Abstract
PURPOSE OF REVIEW To provide an update of glycemic management during metabolic stress related to surgery or critical illness. RECENT FINDINGS There is a clear association between severe hyperglycemia, hypoglycemia, and high glycemic variability and poor outcomes of postoperative or critically ill patients. However, the impressive beneficial effects of tight glycemic management (TGM) by intensive insulin therapy reported in one study were never reproduced. Hence, the recommendation of TGM is now replaced by more liberal blood glucose (BG) targets (< 180 mg/dL or 10 mM). Recent data support the concept of targeting individualized blood glucose (BG) values according to the presence of diabetes mellitus/chronic hyperglycemia, the presence of brain injury, and the time from injury. A more liberal glycemic management goal is currently advised during metabolic stress and could be switched to individualized glycemic management once validated by prospective trials.
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Affiliation(s)
- Wasineenart Mongkolpun
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Bruna Provenzano
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jean-Charles Preiser
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
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Kuntamukkula VKS, Sinha R, Tiwari PK, Bhogavaram B, Subramanium H, Kumar BV, Tiwari RVC. Metabolic response to maxillofacial trauma revisited: A retrospective study. J Family Med Prim Care 2019; 8:3713-3717. [PMID: 31803678 PMCID: PMC6881940 DOI: 10.4103/jfmpc.jfmpc_798_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose: Management of a trauma patient aims at stabilization or resuscitation and revival from critical condition resulting from various sequences of systemic pathophysiological responses in the body. Hematological changes are the first signs reflecting the homeostasis mechanisms starting in the body after injury. The aim of the current study is to evaluate the physiological changes following maxillofacial trauma and extrapolate the findings to understand the posttrauma responses. Patients and Method: This is a retrospective study involving 192 subjects divided into two groups, trauma group and control group. In both the groups, baseline vitals and complete blood picture were recorded for comparison. In trauma group, the recordings were made within 24 h after maxillofacial injury. Results: All the parameters were analyzed using SPSS version 18. Independent sample t-test was used to assess the nature of data distribution and statistical significance was considered only at P value < 0.05. On comparison of complete blood picture mean values of hemoglobin (13.63 vs 12.18), RBC count (4.51 vs 4.10), WBC count (8835.48 vs 8336.56) were seen to be higher in trauma patients compared to control subjects. The mean bleeding times are almost equal (2.35 vs 2.47) but the clotting times (5.42 vs 5.26), random blood glucose (94.78 vs 90.13), and blood urea (27.14 vs 26.30) were marginally higher in trauma group but were statistically insignificant. The mean value of serum creatinine (0.84 vs 0.80) was comparatively higher in trauma patients and was statistically significant. Study of vitals revealed that mean systolic blood pressures were almost equal (120.65 vs 121.08) in both the groups. The mean diastolic blood pressures (79.46 vs 88.49) and oxygen saturation (93.73 vs 98.86) in trauma patients are comparatively reduced. The mean values of temperature (99.30 vs 98.50) and pulse rate (102.38 vs 97.14) were on relatively higher side in trauma group compared with control group. Summary and Conclusion: Using basic blood parameters and vitals in the present study, the compensatory mechanisms happening in the body after maxillofacial trauma can be seen. These changes although significant on side by side comparison can still fall within the normal physiological range provided by various diagnostic setups. Hence, the need for maxillofacial surgeon to be sensitive to minor variations in these aspects to ensure safety of the patient cannot be overemphasized.
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Affiliation(s)
- V K Sasank Kuntamukkula
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Ramen Sinha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Prabhat K Tiwari
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Bharadwaj Bhogavaram
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Himaja Subramanium
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Bheema Vinod Kumar
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Rahul V C Tiwari
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
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Mamtani M, Kulkarni H, Bihari S, Prakash S, Chavan S, Huckson S, Pilcher D. Degree of hyperglycemia independently associates with hospital mortality and length of stay in critically ill, nondiabetic patients: Results from the ANZICS CORE binational registry. J Crit Care 2019; 55:149-156. [PMID: 31731174 DOI: 10.1016/j.jcrc.2019.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE Hyperglycemia (HG) in critically ill patients influences clinical outcomes and hospitalization costs. We aimed to describe association of HG with hospital mortality and length of stay in large scale, real-world scenario. MATERIALS From The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) we included 739,152 intensive care unit (ICU) patients admitted during 2007-2016. Hyperglycemia was quatified using midpoint blood glucose level (MBGL). Association with outcomes (hospital mortality and length of stay (LOS)) was tested using multivariable, mixed effects, 2-level hierarchical regression. RESULTS Degree of HG (defined using MBGL as a continuous variable) was significantly associated with hospital mortality and longer hospital stay in a dose-dependent fashion. The fourth, third and second MBGL (compared to the first) quartiles were associated with hospital mortality (odds ratio 1.34, 1.05 and 0.97, respectively) and longer hospital stay (1.56, 1.38 and 0.93 days, respectively). These associations were stronger associations in trauma (especially head injury), neurological disease and coma patients. Significant variation across ICUs was observed for all associations. CONCLUSIONS In this largest study of nondiabetic ICU patients, HG was associated with both study outcomes. This association was differential across ICUs and diagnostic categories.
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Affiliation(s)
| | | | - Shailesh Bihari
- Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Shivesh Prakash
- Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Shaila Chavan
- The Australian and New Zealand Intensive Care Society (ANZICS), Centre for Outcome and Resource Evaluation (CORE), 277 Camberwell Road, Camberwell, VIC 3124, Australia
| | - Sue Huckson
- The Australian and New Zealand Intensive Care Society (ANZICS), Centre for Outcome and Resource Evaluation (CORE), 277 Camberwell Road, Camberwell, VIC 3124, Australia
| | - David Pilcher
- The Australian and New Zealand Intensive Care Society (ANZICS), Centre for Outcome and Resource Evaluation (CORE), 277 Camberwell Road, Camberwell, VIC 3124, Australia; The Department of Intensive Care, Alfred Health, Commercial Road, Prahran, VIC 3004, Australia; The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Commercial Road, Prahran, VIC, 3004, Australia
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Higher Mortality Rate in Moderate-to-Severe Thoracoabdominal Injury Patients with Admission Hyperglycemia Than Nondiabetic Normoglycemic Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193562. [PMID: 31557789 PMCID: PMC6801625 DOI: 10.3390/ijerph16193562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 02/07/2023]
Abstract
Background: Hyperglycemia at admission is associated with an increase in worse outcomes in trauma patients. However, admission hyperglycemia is not only due to diabetic hyperglycemia (DH), but also stress-induced hyperglycemia (SIH). This study was designed to evaluate the mortality rates between adult moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia as DH or SIH and in patients with nondiabetic normoglycemia (NDN) at a level 1 trauma center. Methods: Patients with a glucose level ≥200 mg/dL upon arrival at the hospital emergency department were diagnosed with admission hyperglycemia. Diabetes mellitus (DM) was diagnosed when patients had an admission glycohemoglobin A1c ≥6.5% or had a past history of DM. Admission hyperglycemia related to DH and SIH was diagnosed in patients with and without DM. Patients who had a thoracoabdominal Abbreviated Injury Scale score <3, a polytrauma, a burn injury and were below 20 years of age were excluded. A total of 52 patients with SIH, 79 patients with DH, and 621 patients with NDN were included from the registered trauma database between 1 January 2009, and 31 December 2018. To reduce the confounding effects of sex, age, comorbidities, and injury severity of patients in assessing the mortality rate, different 1:1 propensity score-matched patient populations were established to assess the impact of admission hyperglycemia (SIH or DH) vs. NDN, as well as SIH vs. DH, on the outcomes. Results: DH was significantly more frequent in older patients (61.4 ± 13.7 vs. 49.8 ± 17.2 years, p < 0.001) and in patients with higher incidences of preexisting hypertension (2.5% vs. 0.3%, p < 0.001) and congestive heart failure (3.8% vs. 1.9%, p = 0.014) than NDN. On the contrary, SIH had a higher injury severity score (median [Q1–Q3], 20 [15–22] vs. 13 [10–18], p < 0.001) than DH. In matched patient populations, patients with either SIH or DH had a significantly higher mortality rate than NDN patients (10.6% vs. 0.0%, p = 0.022, and 5.3% vs. 0.0%, p = 0.043, respectively). However, the mortality rate was insignificantly different between SIH and DH (11.4% vs. 8.6%, odds ratio, 1.4; 95% confidence interval, 0.29–6.66; p = 0.690). Conclusion: This study revealed that admission hyperglycemia in the patients with thoracoabdominal injuries had a higher mortality rate than NDN patients with or without adjusting the differences in patient’s age, sex, comorbidities, and injury severity.
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Emodi NV, Chaiechi T, Beg ABMRA. The impact of climate variability and change on the energy system: A systematic scoping review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 676:545-563. [PMID: 31051363 DOI: 10.1016/j.scitotenv.2019.04.294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/01/2019] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
The energy system is a vital infrastructure which can be vulnerable to climate variability and change (CV&C) impacts. Understanding the impacts can prevent disruption and inform policy decision making. This study applied a scoping review in a systematic manner following the Joanna Briggs Institute guidelines to identify consistent patterns of CV&C impacts on the energy system, map and locate research gaps in the literature. A total of 176 studies were identified as eligible for inclusion in the review. This study found evidence of consistent increase in energy demand for Africa, the Americas and Asian continent. Consistent decrease was found in Northern and Eastern Europe, while increase in residential demand was projected in Oceania. There was evidence of consistent decrease in thermal power plant output globally. Solar photovoltaic showed a robust consistent pattern of increase in the Caribbean and Central America, Northern and Southern Africa and Oceania. As the global climate is changing in a future that is highly uncertain, the energy system should also evolve in order to adapt to the changing climate. Future impact assessment must integrate the impact of CV&C on power demand and supply while consider socioeconomic dynamics, cross-sectoral linkages and back-loops in a complete energy system model.
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Affiliation(s)
- Nnaemeka Vincent Emodi
- Economics and Marketing Academic Group, College of Business, Law and Governance, Division of Tropical Environments and Societies, James Cook University, PO Box 6811, Cairns, QLD 4870, Australia.
| | - Taha Chaiechi
- Economics and Marketing Academic Group, College of Business, Law and Governance, Division of Tropical Environments and Societies, James Cook University, PO Box 6811, Cairns, QLD 4870, Australia
| | - A B M Rabiul Alam Beg
- Department of Economics, College of Business, Law and Governance, Division of Tropical Environments and Societies, James Cook University, PO Box 6811, Townsville, QLD 4811, Australia
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Broadley L, Clark K, Ritchie G. Prevention and management of hyperglycaemic crisis. Nurs Stand 2019; 34:75-82. [PMID: 31468825 DOI: 10.7748/ns.2019.e11387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 06/10/2023]
Abstract
Hyperglycaemia is a defining feature of diabetes mellitus. It involves an elevated level of glucose in the blood, which develops as a result of the body's inability to produce insulin or process insulin effectively. If left unchecked and untreated, patients with diabetes are at risk of short-term, potentially life-threatening hyperglycaemic crises such as diabetic ketoacidosis or hyperosmolar hyperglycaemic state. Nurses frequently care for patients diagnosed with diabetes in various clinical settings; therefore, it is essential that they have an awareness of the prevention and management of hyperglycaemia and hyperglycaemic crises. This article explains the causes and clinical manifestations of hyperglycaemic crises, and details the management of patients with these conditions, in accordance with national guidelines.
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Affiliation(s)
- Lisa Broadley
- School of Health Sciences, University of Central Lancashire, Preston, England
| | - Kerry Clark
- School of Nursing, University of Central Lancashire, Preston, England
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Ben Hamou A, Kipnis E, Elbaz A, Bignon A, Nseir S, Tamion F, Du Cheyron D, Jaillette E, Voisin B, Robriquet L, Vanbaelinghem C, Thellier D, Abi Rached H, Jannin A, Duhamel A, Behal H, Machuron F, Espiard S, Preiser JC, Preau S, Pattou F, Jourdain M. Association of transcription factor 7-like 2 gene (TCF7L2) polymorphisms with stress-related hyperglycaemia (SRH) in intensive care and resulting outcomes: The READIAB study. DIABETES & METABOLISM 2019; 46:243-247. [PMID: 31121319 DOI: 10.1016/j.diabet.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aimed to evaluate the impact of the single nucleotide polymorphism (SNP) rs7903146 on the transcription factor 7-like 2 (TCF7L2) gene in stress-related hyperglycaemia (SRH), defined as blood glucose≥11mmol/L in at least two blood samples during the first 3 days in the intensive care unit (ICU), and on 28-day and 1-year mortality, and incidence of type 2 diabetes (T2D) at 6 months and 1 year in patients hospitalized in the ICU. METHODS This prospective observational (non-interventional) multicentre READIAB study, carried out during 2012-2016 in six French ICUs, involved adult patients admitted to ICUs for at least two organ failures; patients admitted for<48h were excluded. During the 3-day ICU observational period, genetic testing, blood glucose values and insulin treatment were recorded. MAIN RESULTS The association of rs7903146 with SRH was assessed using logistic regression models. Cox proportional hazards regression models assessed the associations between rs7903146 and mortality and between SRH and mortality, both at 28 days and 1 year. A total of 991 of the 1000 enrolled patients were included in the READIAB-G4 cohort, but 242 (24.4%) had preexisting diabetes and were excluded from the analyses. SRH occurred within the first 3 days in the ICU for one-third of the non-diabetes patients. The association between the rs7903146 polymorphism and SRH did not reach significance (P=0.078): OR(peroneTcopy): 1.24, 95% CI: 0.98-1.58. A significant association was found between rs7903146 and 28-day mortality after adjusting for severity scores (P=0.026), but was no longer significant at 1 year (P=0.61). At 28 days, mortality was increased in patients with SRH (HR: 2.09, 95% CI: 1.43-3.06; P<0.001), and remained significant at 1 year after adjusting for severity scores (HR: 1.73, 95% CI: 1.32-2.28; P<0.001). On admission, non-diabetes patients with SRH had a higher incidence of T2D at 6 months vs. those without SRH (16.0% vs. 7.6%, RR: 2.11, 95% CI: 1.07-4.20; P=0.030). At 1 year, these figures were 13.4% vs. 9.2%, RR: 1.45, 95% CI: 0.71-2.96; P=0.31). Moreover, the rs7903146 polymorphism was not significantly associated with T2D development at either 6 months (P=0.72) or 1 year (P=0.64). CONCLUSION This study failed to demonstrate any significant association between rs7903146 and SRH. Nevertheless, the issue remains an important challenge, as SRH may be associated with increased rates of both mortality and T2D development.
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Affiliation(s)
- A Ben Hamou
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France
| | - E Kipnis
- Medical School, université de Lille, 59000 Lille, France; Department of Anesthesiology and Critical care, CHU de Lille, 59000 Lille, France; EA 7366-Host Pathogen Translational Research, université de Lille, 59000 Lille, France
| | - A Elbaz
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - A Bignon
- Department of Anesthesiology and Critical care, CHU de Lille, 59000 Lille, France
| | - S Nseir
- Intensive Care Unit, CHU de Lille, 59000 Lille, France; Medical School, université de Lille, 59000 Lille, France
| | - F Tamion
- Intensive Care Unit, CHU de Rouen, 76031, Rouen, France; UMR 1096 Inserm-Université de Rouen-Biologie, médecine, santé-Endothélium, Valvulopathies et Insuffisance Cardiaque, 76031 Rouen, France
| | - D Du Cheyron
- Intensive Care Unit, CHU de Caen, 14033 Caen, France
| | - E Jaillette
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - B Voisin
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - L Robriquet
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - C Vanbaelinghem
- Intensive Care Unit, Victor Provo Hospital Center, 59100 Roubaix, France
| | - D Thellier
- Intensive Care Unit, Guy Chatiliez Hospital Center, 59200 Tourcoing, France
| | - H Abi Rached
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France
| | - A Jannin
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France
| | - A Duhamel
- Medical School, université de Lille, 59000 Lille, France; EA 2694 - Public Health, Epidemiology and Quality of Care, université de Lille, 59000 Lille, France
| | - H Behal
- EA 2694 - Public Health, Epidemiology and Quality of Care, université de Lille, 59000 Lille, France
| | - F Machuron
- EA 2694 - Public Health, Epidemiology and Quality of Care, université de Lille, 59000 Lille, France
| | - S Espiard
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France; Medical School, université de Lille, 59000 Lille, France
| | - J-C Preiser
- Department of Intensive Care, CUB-Erasme, université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S Preau
- Intensive Care Unit, CHU de Lille, 59000 Lille, France
| | - F Pattou
- Endocrinology, Diabetology and Metabolism, CHU de Lille, 59000 Lille, France; UMR 1190 Inserm Translational research in diabetes, 59000 Lille, France; EGID European Genomics Institute for Diabetes, CHU de Lille, 59000 Lille, France
| | - M Jourdain
- Intensive Care Unit, CHU de Lille, 59000 Lille, France; Medical School, université de Lille, 59000 Lille, France; PRESAGE Simulation Center, université de Lille, 59000 Lille, France; UMR 1190 Inserm Translational research in diabetes, 59000 Lille, France; EGID European Genomics Institute for Diabetes, CHU de Lille, 59000 Lille, France.
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Preiser JC. We need to harmonize our languages! Minerva Anestesiol 2018; 84:1126-1127. [DOI: 10.23736/s0375-9393.18.12983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lheureux O, Prevedello D, Preiser JC. Update on glucose in critical care. Nutrition 2018; 59:14-20. [PMID: 30415158 DOI: 10.1016/j.nut.2018.06.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/08/2018] [Accepted: 06/10/2018] [Indexed: 01/04/2023]
Abstract
The aim of this review is to summarize recent developments on the mechanisms involved in stress hyperglycemia associated with critical illness. Different aspects of the consequences of stress hyperglycemia as well as the therapeutic approaches tested so far are discussed: the physiological regulations of blood glucose, the mechanisms underlying stress hyperglycemia, the clinical associations, and the results of the prospective trials and meta-analyses to be taken into consideration when interpreting the available data. Current recommendations, challenges, and technological hopes for the future are be discussed.
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Affiliation(s)
- Olivier Lheureux
- Department of Intensive Care, CUB-Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Danielle Prevedello
- Department of Intensive Care, CUB-Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Charles Preiser
- Department of Intensive Care, CUB-Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Affiliation(s)
- Jean-Charles Preiser
- Department of Intensive Care, CUB-Erasme, Université Libre de Bruxelles (ULB), 808, route de Lennik, 1070 Brussels, Belgium.
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