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Kanamaru H, Zhu S, Dong S, Takemoto Y, Huang L, Sherchan P, Suzuki H, Tang J, Zhang JH. UDP-Glucose/P2Y14 Receptor Signaling Exacerbates Neuronal Apoptosis After Subarachnoid Hemorrhage in Rats. Stroke 2024; 55:1381-1392. [PMID: 38525592 PMCID: PMC11039370 DOI: 10.1161/strokeaha.123.044422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/13/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is a severe subtype of stroke with poor outcomes. Abnormal glucose metabolism often occurs after SAH, but the strict control of blood glucose levels is not always beneficial. This study aimed to investigate the contribution of uridine diphosphate glucose (UDP-G), an intermediate of glucose/glycogen metabolism, and its receptor P2Y14 (P2Y purinoceptor 14) to SAH pathology and explored the potential targeted treatments in rats. METHODS A total of 218 Sprague-Dawley male rats were used. SAH was induced by endovascular perforation. Brain expressions of P2Y14, uridine diphosphate glucose (UDP-G), and its converting enzyme UGP2 (UDP-G pyrophosphorylase-2) were evaluated. Exogenous UDP-G or selective P2Y14 inhibitor was administered intranasally at 1 hour after SAH to explore their potential effects. Intranasal Ugp2 or P2ry14 siRNA was delivered 24 hours before SAH for mechanistic evaluation. Primary neuron culture and hemoglobin stimulation were used as in vitro model of SAH. Post-SAH evaluation included liquid chromatography-mass spectrometry measurement of brain endogenous UDP-G level, neurobehavioral assessments, Western blotting, immunohistochemistry, TUNEL staining, and Nissl staining. RESULTS There was an acute elevation of endogenous brain UDP-G and UGP2 after SAH, and P2Y14 was expressed in neurons. Although P2Y14 inhibitor decreased neurological dysfunction, neuronal apoptosis, and proapoptotic molecules, exogenous UDP-G exacerbated these outcomes at 24 hours after SAH. Early inhibition of P2Y14 preserved long-term neuronal survival in the hippocampus, amygdala, and cortex with improved neurocognition and depressive-like behavior. In addition, in vivo knockdown of Ugp2- and P2ry14-reduced neurological deficits and proapoptotic molecules at 24 hours after SAH, and furthermore in vitro knockdown of P2ry14-reduced apoptosis in hemoglobin stimulated primary neuron. CONCLUSIONS These findings suggest a detrimental role of brain UDP-G/P2Y14 signaling in SAH, as a part of glucose metabolic pathology at the tissue level. P2Y14 inhibitor 4-[4-(4-piperidinyl)phenyl]-7-[4-(trifluoromethyl)phenyl]-2-naphthalenecarboxylic acid hydrochloride may serve as a potential therapeutic target in treating patients with SAH.
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Affiliation(s)
- Hideki Kanamaru
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H.K., H.S.)
| | - Shiyi Zhu
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
| | - Siyuan Dong
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
| | - Yushin Takemoto
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
- Department of Neurosurgery, Kumamoto University School of Medicine, Japan (Y.T.)
| | - Lei Huang
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
- Neurosurgery, (L.H., J.H.Z.), Loma Linda University, CA
| | - Prativa Sherchan
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H.K., H.S.)
| | - Jiping Tang
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
| | - John H Zhang
- Departments of Physiology and Pharmacology (H.K., S.Z., S.D., Y.T., L.H., P.S., J.T., J.H.Z.,), Loma Linda University, CA
- Neurosurgery, (L.H., J.H.Z.), Loma Linda University, CA
- Anesthesiology (J.H.Z.), Loma Linda University, CA
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Li J, Liu BJ, Wang YJ, Cui Y, Chen HS. Antihypertensive Drugs Affect the Association of Systolic Blood Pressure Variability with Outcomes in Patients with Acute Stroke who had Successful Recanalization after Endovascular Treatment. J Atheroscler Thromb 2024; 31:616-625. [PMID: 38220185 PMCID: PMC11079479 DOI: 10.5551/jat.64637] [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: 09/25/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024] Open
Abstract
AIMS Blood pressure variability (BPV) was associated with the clinical outcomes in patients with acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) after endovascular treatment (EVT). This study aimed to investigate whether the use of antihypertensive drugs could affect this association in patients with AIS-LVO after EVT. METHODS We retrospectively screened consecutive patients with AIS-LVO who had successful recanalization after EVT and calculated their systolic BPV (SBPV) during the first 24 h after EVT using eight statistical methodologies based on previously published literature. Poor outcome was defined as a modified Rankin Scale score of 3-6 at 90 days. Logistic regression analysis was performed to assess this association, and different prediction models were constructed to assess the effect of the use of antihypertensive drugs. RESULTS A total of 214 patients were finally included, including 92 (43.0%) with good outcomes, and 136 (63.6%) who received antihypertensive drugs. SBPV indicators were significantly lower in patients with good outcomes versus those with poor outcomes. The logistic analysis showed that all SBPV indicators were consistently associated with poor outcomes (odds ratio, 1.031-1.282, all P<0.05) in all populations, which was confirmed in patients not using antihypertensive drugs. However, no SBPV indicator was found to be associated with poor outcomes in patients using antihypertensive drugs. Receiver operating characteristic curves showed that the area under the curve (AUC) was larger in the model adjusting for antihypertensive drugs (AUC 0.774-0.783) compared with the one not adjusted for antihypertensive drugs (AUC 0.739-0.754). CONCLUSION In the anterior circulation of patients with AIS-LVO who had successful recanalization after EVT, the utilization of antihypertensive drugs may have some impact on the relationship between SBPV and clinical outcomes.
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Affiliation(s)
- Jing Li
- Department of Neurology, General Hospital of Northern Theater Command; Shenyang, China
| | - Bai-Jun Liu
- Department of Neurology, General Hospital of Northern Theater Command; Shenyang, China
| | - Ying-Jia Wang
- Department of Neurology, General Hospital of Northern Theater Command; Shenyang, China
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theater Command; Shenyang, China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command; Shenyang, China
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Hryciw BN, Ghossein J, Rochwerg B, Meggison H, Fernando SM, Kyeremanteng K, Tran A, Seely AJE. Glycemic Variability As a Prognostic Factor for Mortality in Patients With Critical Illness: A Systematic Review and Meta-Analysis. Crit Care Explor 2024; 6:e1025. [PMID: 38222872 PMCID: PMC10786590 DOI: 10.1097/cce.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES To perform a systematic review and meta-analysis to evaluate the association of various measures of glycemic variability, including time-domain and complexity-domain, with short-term mortality in patients with critical illness. DATA SOURCES We searched Embase Classic +, MEDLINE, and the Cochrane Database of Systematic Reviews from inception to November 3, 2023. STUDY SELECTION We included English language studies that assessed metrics of glycemic variation or complexity and short-term mortality in patients admitted to the ICU. DATA EXTRACTION Two authors performed independent data abstraction and risk-of-bias assessments. We used a random-effects model to pool binary and continuous data and summarized estimates of effect using odds ratios and mean difference. We used the Quality in Prognosis Studies tool to assess risk of bias and the Grading of Recommendations, Assessment, Development and Evaluations to assess certainty of pooled estimates. DATA SYNTHESIS We included 41 studies (n = 162,259). We demonstrate that increased sd, coefficient of variance, glycemic lability index, and decreased time in range are probably associated with increased mortality in critically ill patients (moderate certainty) and that increased mean absolute glucose, mean amplitude of glycemic excursion, and detrended fluctuation analysis may be associated with increased mortality (low certainty). CONCLUSIONS We found a consistent association between increased measures of glycemic variability and higher short-term mortality in patient with critical illness. Further research should focus on standardized measurements of glycemic variation and complexity, along with their utility as therapeutic targets and prognostic markers.
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Affiliation(s)
- Brett N Hryciw
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jamie Ghossein
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Hilary Meggison
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shannon M Fernando
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandre Tran
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew J E Seely
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Jiao X, Wang H, Li M, Lu Y. Glycemic Variability and Prognosis of Patients with Intracerebral Hemorrhage: A Meta-Analysis. Horm Metab Res 2023; 55:176-183. [PMID: 36848928 DOI: 10.1055/a-2010-2345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Glycemic disorder may affect the outcomes of patients with intracerebral hemorrhage (ICH). However, the association between glycemic variability (GV) and prognosis in these patients remains to be determined. We performed a meta-analysis to compressive the influence of GV on functional outcome and mortality in patients with ICH. Observational studies comparing the risks of poor functional outcome (defined as modified Rankin Scale>2) and all-cause mortality between ICH patients with higher versus lower acute GV were retrieved by systematic search of Medline, Web of Science, Embase, CNKI, and Wanfang databases. A random-effect model was used to pool the data after incorporating the between-study heterogeneity. Sensitivity analyses were performed to evaluate the stability of the findings. Eight cohort studies involving 3400 patients with ICH were included in the meta-analysis. The follow-up duration was within 3 months after admission. All of the included studies used standard deviation of blood glucose (SDBG) as the indicator of acute GV. Pooled results showed that ICH patients with higher SDBG were associated with a higher risk of poor functional outcome as compared to those with lower SDBG [risk ratio (RR): 1.84, 95% confidence interval (CI): 1.41 to 2.42, p<0.001, I2=0%]. In addition, patients with higher category of SDBG were also associated with a higher mortality risk (RR: 2.39, 95% CI: 1.79 to 3.19, p<0.001, I2=0%). In conclusion, high acute GV may be a predictor of poor functional outcome and mortality of patients with ICH.
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Affiliation(s)
- Xu Jiao
- Emergency Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huifang Wang
- Emergency Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingfei Li
- Emergency Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yun Lu
- Emergency Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Santana D, Mosteiro A, Pedrosa L, Llull L, Torné R, Amaro S. Clinical relevance of glucose metrics during the early brain injury period after aneurysmal subarachnoid hemorrhage: An opportunity for continuous glucose monitoring. Front Neurol 2022; 13:977307. [PMID: 36172028 PMCID: PMC9512056 DOI: 10.3389/fneur.2022.977307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Hyperglycaemia, hypoglycaemia and higher glucose variability during the Early Brain Injury (EBI) period of aneurysmal subarachnoid hemorrhage (aSAH) have been associated with poor clinical outcome. However, it is unclear whether these associations are due to direct glucose-driven injury or if hyperglycaemia simply acts as a marker of initial severity. Actually, strict glucose control with intensive insulin therapy has not been demonstrated as an effective strategy for improving clinical outcomes after aSAH. Currently published studies describing an association between hyperglycaemia and prognosis in aSAH patients have been based on isolated glucose measurements and did not incorporate comprehensive dynamic evaluations, such as those derived from subcutaneous continuous glucose monitoring devices (CMG). Arguably, a more accurate knowledge on glycaemic patterns during the acute phase of aSAH could increase our understanding of the relevance of glycaemia as a prognostic factor in this disease as well as to underpin its contribution to secondary focal and diffuse brain injury. Herein, we have summarized the available evidence on the diagnostic and prognostic relevance of glucose metrics during the acute phase of cerebrovascular diseases, focusing in the EBI period after aSAH. Overall, obtaining a more precise scope of acute longitudinal glucose profiles could eventually be useful for improving glucose management protocols in the setting of acute aSAH and to advance toward a more personalized management of aSAH patients during the EBI phase.
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Affiliation(s)
- Daniel Santana
- Comprehensive Stroke Center, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alejandra Mosteiro
- Neurosurgery Department, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Leire Pedrosa
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Llull
- Comprehensive Stroke Center, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ramón Torné
- Neurosurgery Department, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- *Correspondence: Ramón Torné
| | - Sergi Amaro
- Comprehensive Stroke Center, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Sergi Amaro
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Wang JH, Li H, Yang HK, Chen RD, Yu JS. Relationship between the mean of 24-h venous blood glucose and in-hospital mortality among patients with subarachnoid hemorrhage: A matched cohort study. Front Neurol 2022; 13:904293. [PMID: 35983431 PMCID: PMC9379100 DOI: 10.3389/fneur.2022.904293] [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] [Received: 03/25/2022] [Accepted: 07/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to explore the correlation between the mean of 24-h venous blood glucose (BG) and in-hospital mortality and all-cause mortality (ACM) in patients with subarachnoid hemorrhage (SAH). Methods Detailed clinical information was acquired from the Medical Information Mart for Intensive IV (MIMIC-IV) database. The best cutoff value of mean BG was calculated using the X-tile program. Univariate and multivariate logistic regressive analyses were utilized to analyze the prognosis significance of mean BG, and survival curves were drawn using the Kaplan-Meier (K-M) approach. To improve the reliability of results and balance the impact of underlying confounders, the 1:1 propensity score matching (PSM) approach was utilized. Results An overall of 1,230 subjects were selected herein. The optimal cutoff value of the mean BG for in-hospital mortality was 152.25. In addition, 367 pairs of score-matched subjects were acquired after PSM analysis, and nearly all variables' differences were balanced. K-M analysis showed that patients with mean BG ≥ 152.25 mg/dl had significantly higher in-hospital, 3-month, and 6-month mortalities compared with patients with mean BG < 152.25 mg/dl (p < 0.001). The multivariable logistic regressive analyses revealed that patients with mean BG ≥ 152.25 mg/dl had significantly increased in-hospital mortality compared with patients with mean BG < 152.25 mg/dl after the adjustment for possible confounders (OR = 1.994, 95% CI: 1.321–3.012, p = 0.001). Similar outcomes were discovered in the PSM cohort. Conclusion Our data suggested that mean BG was related to ACM of patients with SAH. More studies are needed to further analyze the role of the mean of 24-h venous BG in patients with SAH.
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Jia L, Zhang Y, Wang P, Wang X, Nie XQ, Yao W, Li T, Chen L, Chong W, Hai Y, You C, Chen Y, Fang F, Ji H, Li R. Association between hyperglycemia at admission and mortality in aneurysmal subarachnoid hemorrhage. J Clin Neurosci 2022; 103:172-179. [PMID: 35907352 DOI: 10.1016/j.jocn.2022.07.007] [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: 02/23/2022] [Revised: 06/07/2022] [Accepted: 07/09/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Elevated blood glucose is frequently detected early after aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate whether hyperglycemia at admission is associated with mortality in patients with aSAH. METHODS In a multicenter observational study of patients with aSAH, we defined normal glycemia, mild hyperglycemia, moderate hyperglycemia, and severe hyperglycemia as blood glucose of 4.00-6.09 mmol/L, 6.10-7.80 mmol/L, 7.81-10.00 mmol/L, and > 10.00 mmol/L, respectively. We performed propensity score matching to obtain the adjusted odds ratios (OR) with 95 % confidence intervals (CI). RESULTS Of 6771 patients with aSAH, 511(7.5 %) had died in hospital, and hyperglycemia at admission was observed in 4804 (70.9 %). Propensity scores matching analyses indicated that compared with normal glycemia, the odds of in-hospital mortality were slightly lower in patients with mild hyperglycemia (OR 0.89, 95 % CI 0.56-1.40), significantly higher in patients with moderate hyperglycemia (OR 1.90, 95 % CI 1.20-3.01), and in patients with severe hyperglycemia (OR 3.45, 95 % CI 2.15-5.53; P trend < 0.001). Long-term survival was worse among patients with hyperglycemia and was proportional to its severity. Similar dose-response associations were evident for poor functional outcomes and major disability. Hyperglycemia was associated with an increased risk of hospital-acquired infections (OR 1.46, 95 % CI 1.29-1.66) and rebleeding (OR 1.58, 95 % CI 1.06-2.35). CONCLUSIONS Among aSAH patients, hyperglycemia at admission was independently associated with increased mortality. Both moderate hyperglycemia and severe hyperglycemia were associated with an increased risk of mortality, but these associations were not seen in mild hyperglycemia (blood glucose 6.10-7.80 mmol/L).
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Affiliation(s)
- Lu Jia
- Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Yu Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Xing Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Qi Nie
- Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Wei Yao
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Tiangui Li
- Department of Neurosurgery, West China Longquan Hospital Sichuan University, Chengdu, Sichuan, China
| | - Lvlin Chen
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yongzhong Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongming Ji
- Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China.
| | - Rongshan Li
- Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China.
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Dong M, Liu W, Luo Y, Li J, Huang B, Zou Y, Liu F, Zhang G, Chen J, Jiang J, Duan L, Xiong D, Fu H, Yu K. Glycemic Variability Is Independently Associated With Poor Prognosis in Five Pediatric ICU Centers in Southwest China. Front Nutr 2022; 9:757982. [PMID: 35284444 PMCID: PMC8905539 DOI: 10.3389/fnut.2022.757982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background Glucose variability (GV) is a common complication of dysglycemia in critically ill patients. However, there are few studies on the role of GV in the prognosis of pediatric patients, and there is no consensus on the appropriate method for GV measurement. The objective of this study was to determine the “optimal” index of GV in non-diabetic critically ill children in a prospective multicenter cohort observational study. Also, we aimed to confirm the potential association between GV and unfavorable outcomes and whether this association persists after controlling for hypoglycemia or hyperglycemia. Materials and Methods Blood glucose values were recorded for the first 72 h and were used to calculate the GV for each participant. Four different metrics [SD, glycemic lability index (GLI), mean absolute glucose (MAG), and absolute change of percentage (ACACP)] were considered and compared to identify the “best” GV index associated with poor prognosis in non-diabetic critically ill children. Among the four metrics, the SD was most commonly used in previous studies, while GLI- and MAG-integrated temporal information, that is the rate and magnitude of change and the time interval between glucose measurements. The fourth metric, the average consecutive ACACP, was introduced in our study, which can be used in real-time clinical decisions. The primary outcome of this study was the 28-day mortality. The receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive power of different metrics of GV for the primary outcome. The GV index with the largest area under ROC curve (AUC) was chosen for subsequent multivariate analyses. Multivariate Cox regression analysis was performed to identify the potential predictors of the outcome. To compare the contribution in 28-day mortality prognosis between glycemic variability and hyper- or hypoglycemia, performance metrics were calculated, which included AUC, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results Among 780 participants, 12.4% (n = 97) died within 28 days after admission to the pediatric intensive care unit (PICU). Statistically significant differences were found between survivors and non-survivors in terms of four GV metrics (SD, GLI, MAG, and ACACP), in which MAG (AUC: 0.762, 95% CI: 0.705–0.819, p < 0.001) achieved the largest AUC and showed a strong independent association with ICU mortality. Subsequent addition of MAG to the multivariate Cox model for hyperglycemia resulted in further quantitative evolution of the model statistics (AUC = 0.651–0.681, p = 0.001; IDI: 0.017, p = 0.044; NRI: 0.224, p = 0.186). The impact of hyperglycemia (adjusted hazard ratio [aHR]: 1.419, 95% CI: 0.815–2.471, p = 0.216) on outcome was attenuated and no longer statistically relevant after adjustment for MAG (aHR: 2.455, 95% CI: 1.411–4.270, p = 0.001). Conclusions GV is strongly associated with poor prognosis independent of mean glucose level, demonstrating more predictive power compared with hypoglycemia and hyperglycemia after adjusting for confounding factors. GV metrics that contain information, such as time and rate of change, are the focus of future research; thus, the MAG may be a good choice. The findings of this study emphasize the crucial role of GVs in children in the PICU. Clinicians should pay more attention to GV for clinical glucose management.
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Affiliation(s)
- Milan Dong
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Department of Pediatrics, The People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Wenjun Liu
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yetao Luo
- Department of Clinical Epidemiology and Biostatistics, Children's Institute of Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Li
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- *Correspondence: Jing Li
| | - Bo Huang
- Department of Pediatric Critical Care, The First People's Hospital of Zunyi, Zunyi, China
| | - Yingbo Zou
- Department of Pediatric Critical Care, The First People's Hospital of Zunyi, Zunyi, China
| | - Fuyan Liu
- Department of Pediatric Critical Care, The First People's Hospital of Zunyi, Zunyi, China
| | - Guoying Zhang
- Department of Pediatric Critical Care, Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Ju Chen
- Department of Pediatric Critical Care, Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Jianyu Jiang
- Department of Pediatrics, Chongqing Three Gorges Women and Children's Hospital, Chongqing, China
| | - Ling Duan
- Department of Pediatrics, Chongqing Three Gorges Women and Children's Hospital, Chongqing, China
| | - Daoxue Xiong
- Department of Pediatrics, Chongqing Three Gorges Women and Children's Hospital, Chongqing, China
| | - Hongmin Fu
- Department of Pediatric Critical Care, Kunming Children's Hospital, Kunming, China
| | - Kai Yu
- Department of Pediatric Critical Care, Kunming Children's Hospital, Kunming, China
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Behravesh M, Fernandez-Tajes J, Estampador AC, Varga TV, Gunnarsson ÓS, Strevens H, Timpka S, Franks PW. A prospective study of the relationships between movement and glycemic control during day and night in pregnancy. Sci Rep 2021; 11:23911. [PMID: 34903782 PMCID: PMC8668873 DOI: 10.1038/s41598-021-03257-0] [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] [Received: 07/26/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
Both disturbed sleep and lack of exercise can disrupt metabolism in pregnancy. Accelerometery was used to objectively assess movement during waking (physical activity) and movement during sleeping (sleep disturbance) periods and evaluated relationships with continuous blood glucose variation during pregnancy. Data was analysed prospectively. 15-women without pre-existing diabetes mellitus wore continuous glucose monitors and triaxial accelerometers from February through June 2018 in Sweden. The relationships between physical activity and sleep disturbance with blood glucose rate of change were assessed. An interaction term was fitted to determine difference in the relationship between movement and glucose variation, conditional on waking/sleeping. Total movement was inversely related to glucose rate of change (p < 0.001, 95% CI (− 0.037, − 0.026)). Stratified analyses showed total physical activity was inversely related to glucose rate of change (p < 0.001, 95% CI (− 0.040, − 0.028)), whereas sleep disturbance was not related to glucose rate of change (p = 0.07, 95% CI (< − 0.001, 0.013)). The interaction term was positively related to glucose rate of change (p < 0.001, 95% CI (0.029, 0.047)). This study provides temporal evidence of a relationship between total movement and glycemic control in pregnancy, which is conditional on time of day. Movement is beneficially related with glycemic control while awake, but not during sleep.
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Affiliation(s)
- Masoud Behravesh
- Genetic & Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35 214 28, Malmö, Sweden
| | - Juan Fernandez-Tajes
- Genetic & Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35 214 28, Malmö, Sweden
| | - Angela C Estampador
- Genetic & Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35 214 28, Malmö, Sweden
| | - Tibor V Varga
- Genetic & Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35 214 28, Malmö, Sweden.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ómar S Gunnarsson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden.,Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Helena Strevens
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden
| | - Simon Timpka
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden.,Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Paul W Franks
- Genetic & Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35 214 28, Malmö, Sweden. .,Harvard TH Chan School of Public Health, Boston, MA, USA.
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Kim TJ, Lee JS, Park SH, Ko SB. Short-term glycemic variability and hemorrhagic transformation after successful endovascular thrombectomy. Transl Stroke Res 2021; 12:968-975. [PMID: 33576937 DOI: 10.1007/s12975-021-00895-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Glycemic variability (GV) is a risk factor for poor outcomes after ischemic stroke. However, its effect on hemorrhagic transformation after endovascular recanalization therapy (ERT) remains to be elucidated. METHODS Patients with acute ischemic stroke due to large vessel occlusion with successful recanalization after ERT (modified thrombolysis in cerebral infarction 2b or 3) were enrolled between January 2013 and November 2019. Blood glucose level data were obtained during the first 36 h after ERT, and ten GV parameters including time rate (TR) of glucose variation were assessed. The TR of glucose variation reflects the speed of glucose fluctuations over time (mg/dL/hour) during the monitoring period. Symptomatic intracerebral hemorrhage (sICH) and unfavorable outcomes at 3 months after ERT were analyzed. The sICH was defined as parenchymal hematoma type 2 with a neurological deterioration of 4 points or more on the National Institute of Health Stroke Scale. Moreover, a modified Rankin Scale of 3-6 at 3 months was considered an unfavorable outcome. RESULTS Among all patients (n = 176; mean age, 69.3 years; 47.7 % female), sICH developed after successful ERT in 16 (9.1%) patients. In addition, 54% (n = 95) patients had an unfavorable outcome at 3 months. Patients with sICH and unfavorable outcome had higher the TR of glucose variation. After adjusting for potential confounders, the TR of glucose (per 1 mg/dL/h increase) variation was independently associated with sICH (odds ratio, 1.17; 95% confidence interval [CI], 1.012-1.343) and 3-month unfavorable outcome (OR 1.14, 95% CI, 1.000-1.297). CONCLUSIONS Time-related GV during the first 36 h after successful ERT has a stronger correlation with sICH and poor functional outcomes compared to any GV parameters. This suggests that maintaining stable glucose may be an important factor in the prevention of sICH after undergoing successful ERT.
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Affiliation(s)
- Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Sung Lee
- Department of Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Hyun Park
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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