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Chu C, Li J, Yang X, Zhao H, Wu Z, Xu R, Gao J. Continuous glucose monitoring versus conventional glucose monitoring in the ICU: A randomized controlled trial. J Crit Care 2024; 84:154894. [PMID: 39106581 DOI: 10.1016/j.jcrc.2024.154894] [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: 03/22/2024] [Revised: 07/20/2024] [Accepted: 07/29/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE This study evaluated the clinical utility of continuous glucose monitoring system (CGMS) in critically ill patients. METHODS In this randomized controlled trial, we randomly assigned critically ill participants with diabetes or stress-induced hyperglycemia to the CGMS group (n = 48) or to the conventional point-of-care monitoring (POCM) group (n = 48). The glucose values and clinical outcome were compared between the two group. The primary endpoint was 28-day mortality after intensive care unit admission. RESULTS The 28-day mortality was not significantly different between the CGMS and POCM group (20.8% vs 31.3%, P = 0.25). The mean glucose, time-weighted average glucose, glucose standard deviation and time in range (3.9-10.0) were significantly improved in the CGMS group (all P < 0.05). CONCLUSION Compared with conventional POCM, CGMS did not decrease the 28-day mortality in critically ill participants with diabetes or stress-induced hyperglycemia. But CGMS may improve the glycemic control and may be increasingly used in critically ill patients.
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Affiliation(s)
- Chen Chu
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jian Li
- Department of Anesthesiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - XiaoDong Yang
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - HuiJing Zhao
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - ZaiXian Wu
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - RuoXin Xu
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - JianLing Gao
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Intensive Care Unit of Anesthesia, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Bann SA, Hercus JC, Atkins P, Alkhairy A, Loyal JP, Sekhon M, Thompson DJ. Accuracy of a Continuous Glucose Monitor in the Intensive Care Unit: A Proposed Accuracy Standard and Calibration Protocol for Inpatient Use. Diabetes Technol Ther 2024. [PMID: 38913325 DOI: 10.1089/dia.2024.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Background and Aims: Guidelines now recommend inpatient continuous glucose monitor (CGM) use with confirmatory blood glucose measurements. However, the Food and Drug Administration has not yet officially approved CGM for inpatient use in large part because its accuracy has not been established in this setting. We tested the accuracy of the Dexcom G6 (G6) in 28 adults on an insulin infusion in a medical-surgical intensive care unit with 1064 matched CGM and arterial point-of-care pairs. Methods: The participants were on average 57.29 (SD 2.39) years, of whom 13 had a prior diagnosis of diabetes and 14 were admitted for a surgical diagnosis. The first 19 participants received the G6 without calibration and had a mean absolute relative difference (MARD) of 13.19% (IQR 5.11, 19.03) across 659 matched pairs, which just meets the critical care expert recommendation of MARD <14%. We then aimed to improve accuracy for the subsequent 9 participants using a calibration protocol. Results: The MARD for calibrated participants was 9.65% (3.03, 13.33), significantly lower than for uncalibrated participants (P < 0.001). Calibration also demonstrated excellent safety with 100% of values within the Clarke Error Grid zones A and B compared with 99.07% without calibration. Our protocol achieved the lowest MARD and safest CEG profile in the critical care setting and well exceeds the critical care expert recommendations. Our large sample of heterogenous critically ill patients also reached comparable accuracy to the MARD of 9% for G6 in outpatients. We believe our calibration protocol will allow G6 to be used with sufficient accuracy in inpatients.
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Affiliation(s)
- Sewon A Bann
- Division of Endocrinology, University of British Columbia, Vancouver, Canada
| | - Jess C Hercus
- Department of Biological Sciences, Simon Fraser University, Burnaby, Canada
| | - Paul Atkins
- Division of Endocrinology, University of British Columbia, Vancouver, Canada
| | - Areej Alkhairy
- Division of Endocrinology, University of British Columbia, Vancouver, Canada
| | - Jackson P Loyal
- Deanery of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Mypinder Sekhon
- Division of Critical Care, University of British Columbia, Vancouver, Canada
| | - David J Thompson
- Division of Endocrinology, University of British Columbia, Vancouver, Canada
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Estrada-Bernal A, Sharma L, Shah FA. "When the Going Gets Tough": Novel Roles for TRPV4 in Stiffness-induced Phagolysosome Maturation. Am J Respir Cell Mol Biol 2024; 70:431-432. [PMID: 38502902 PMCID: PMC11160420 DOI: 10.1165/rcmb.2024-0070ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/19/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Adriana Estrada-Bernal
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine University of Pittsburgh Pittsburgh, Pennsylvania
| | - Lokesh Sharma
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine University of Pittsburgh Pittsburgh, Pennsylvania
| | - Faraaz Ali Shah
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine University of Pittsburgh
- Veterans Affairs Pittsburgh Healthcare System Pittsburgh, Pennsylvania
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Guo Y, Qiu Y, Xue T, Zhou Y, Yan P, Liu S, Liu S, Zhao W, Zhang N. Association between glycemic variability and short-term mortality in patients with acute kidney injury: a retrospective cohort study of the MIMIC-IV database. Sci Rep 2024; 14:5945. [PMID: 38467770 PMCID: PMC10928232 DOI: 10.1038/s41598-024-56564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
Acute kidney injury (AKI) represents a significant challenge to global public health problem and is associated with poor outcomes. There is still considerable debate about the effect of mean blood glucose (MBG) and coefficient of variation (CV) of blood glucose on the short-term mortality of AKI patients. This retrospective cohort study aimed to explore the association between glycemic variability and short-term mortality in patients with AKI. Data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were analyzed, including 6,777 adult AKI patients. MBG and CV on the first day of ICU admission were calculated to represent the overall glycemic status and variability during the ICU stay in AKI patients. The primary outcome indicator was ICU 30-day mortality of AKI patients. Multivariate Cox regression analysis and smoothed curve fitting were used to assess the relationship between blood glucose levels and mortality. Eventually, the ICU 30-day mortality rate of AKI patients was 23.5%. The increased MBG and CV were significantly correlated with ICU 30-day mortality (hazards ratio (HR) = 1.20, 95% confidence interval (CI) 1.14-1.27; HR = 1.08, 95% CI 1.03-1.13). The smoothed curve fitting showed a U-shaped relationship between MBG on the first day of ICU admission and ICU 30-day mortality (inflection point = 111.3 mg/dl), while CV had a linear relationship with 30-day ICU mortality. Thus, we conclude that MBG and CV were significantly associated with short-term mortality in intensive care patients with AKI. Tighter glycemic control may be an effective measure to improve the prognosis of patients with AKI.
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Affiliation(s)
- Yifan Guo
- Department of Endocrinology and Nephropathy, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Qiu
- Department of Endocrinology, Miyun Hospital District, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Taiqi Xue
- Department of Endocrinology and Nephropathy, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Zhou
- Department of Endocrinology and Nephropathy, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Pu Yan
- Department of Endocrinology and Nephropathy, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Shiyi Liu
- Department of Nephropathy, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Shiwei Liu
- Department of Endocrinology and Nephropathy, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Wenjing Zhao
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
| | - Ning Zhang
- Department of Endocrinology and Nephropathy, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
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Kang C, Choi S, Jang EJ, Joo S, Jeong JH, Oh SY, Ryu HG, Lee H. Prevalence and outcomes of chronic comorbid conditions in patients with sepsis in Korea: a nationwide cohort study from 2011 to 2016. BMC Infect Dis 2024; 24:184. [PMID: 38347513 PMCID: PMC10860243 DOI: 10.1186/s12879-024-09081-x] [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: 08/17/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Chronic comorbid conditions are common in patients with sepsis and may affect the outcomes. This study aimed to evaluate the prevalence and outcomes of common comorbidities in patients with sepsis. METHODS We conducted a nationwide retrospective cohort study. Using data from the National Health Insurance Service of Korea. Adult patients (age ≥ 18 years) who were hospitalized in tertiary or general hospitals with a diagnosis of sepsis between 2011 and 2016 were analyzed. After screening of all International Classification of Diseases 10th revision codes for comorbidities, we identified hypertension, diabetes mellitus (DM), liver cirrhosis (LC), chronic kidney disease (CKD), and malignancy as prevalent comorbidities. RESULTS Overall, 373,539 patients diagnosed with sepsis were hospitalized in Korea between 2011 and 2016. Among them, 46.7% had hypertension, 23.6% had DM, 7.4% had LC, 13.7% had CKD, and 30.7% had malignancy. In-hospital mortality rates for patients with hypertension, DM, LC, CKD, and malignancy were 25.5%, 25.2%, 34.5%, 28.0%, and 33.3%, respectively, showing a decreasing trend over time (P < 0.001). After adjusting for baseline characteristics, male sex, older age, use of mechanical ventilation, and continuous renal replacement therapy, LC, CKD, and malignancy were significantly associated with in-hospital mortality. CONCLUSIONS Hypertension is the most prevalent comorbidity in patients with sepsis, and it is associated with an increased survival rate. Additionally, liver cirrhosis, chronic kidney disease, and malignancy result in higher mortality rates than hypertension and DM, and are significant risk factors for in-hospital mortality in patients with sepsis.
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Affiliation(s)
- Christine Kang
- Departments of Critical Care Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, South Korea
| | - Somin Joo
- Departments of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jae Hoon Jeong
- Departments of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seung-Young Oh
- Departments of Critical Care Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ho Geol Ryu
- Departments of Critical Care Medicine, Seoul National University Hospital, Seoul, South Korea
- Departments of Anesthesiology and Pain Medicine, Seoul National University, College of Medicine, Seoul, South Korea
| | - Hannah Lee
- Departments of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea.
- Departments of Anesthesiology and Pain Medicine, Seoul National University, College of Medicine, Seoul, South Korea.
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Kumar KR, Shah SJ, Fayyad RM, Turla TM, O'Sullivan LM, Wallace B, Clark RH, Benjamin DK, Greenberg RG, Hornik CP. Association Between Hypoglycemia and the Occurrence of Early Onset Sepsis in Premature Infants. J Pediatric Infect Dis Soc 2023; 12:S28-S36. [PMID: 38146863 DOI: 10.1093/jpids/piad067] [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: 06/20/2023] [Accepted: 09/08/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND We examined the association between hypoglycemia and the occurrence of early onset sepsis (EOS) in premature infants admitted to the neonatal intensive care unit (NICU). METHODS We included infants discharged from 358 NICUs between 1997 and 2020 with gestational age <34 weeks, ≥1 culture collected in the first 3 days of life, and ≥1 serum glucose value recorded on the day of or day prior to culture collection. We used multivariable logistic regression and inverse probability weighting (IPW) and constructed models for three definitions of hypoglycemia: American Academy of Pediatrics (AAP), Pediatric Endocrine Society, and a definition based on neurodevelopmental studies. We performed subgroup analysis in EOS episodes caused by Gram-negative and Gram-positive organisms. RESULTS Of the 62,178 infants and 64,559 cultures that met study inclusion criteria, 739 (1%) cultures were positive. The median (25th, 75th percentile) glucose value was 75 mg/dL (50, 106) on the day of or day prior to a positive culture versus 70 mg/dL (50, 95) on the day of or day prior to a negative culture. We found that hypoglycemia was not associated with the occurrence of EOS for all organisms and Gram-positive organisms, whereas there was a small but significant association between the lower AAP glucose cutoff value and EOS due to Gram-negative organisms (logistic regression: risk difference [RD] 0.24% [95% CI, 0.01-0.47]; IPW: RD 0.22% [95% CI, 0.00-0.43]). CONCLUSIONS Hypoglycemia may be an early marker of EOS, particularly in episodes caused by Gram-negative organisms and when using a stricter definition of hypoglycemia.
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Affiliation(s)
- Karan R Kumar
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Sonam J Shah
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Rawan M Fayyad
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Toby M Turla
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Laura M O'Sullivan
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Beatriz Wallace
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, Florida, USA
| | - Daniel K Benjamin
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
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7
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van Herpt TTW, van Rosmalen F, Hulsewé HPMG, van der Horst-Schrivers ANA, Driessen M, Jetten R, Zelis N, de Galan BE, van Kuijk SMJ, van der Horst ICC, van Bussel BCT. Hyperglycemia and glucose variability are associated with worse survival in mechanically ventilated COVID-19 patients: the prospective Maastricht Intensive Care Covid Cohort. Diabetol Metab Syndr 2023; 15:253. [PMID: 38057908 DOI: 10.1186/s13098-023-01228-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Data on hyperglycemia and glucose variability in relation to diabetes mellitus, either known or unknown in ICU-setting in COVID-19, are scarce. We prospectively studied daily glucose variables and mortality in strata of diabetes mellitus and glycosylated hemoglobin among mechanically ventilated COVID-19 patients. METHODS We used linear-mixed effect models in mechanically ventilated COVID-19 patients to investigate mean and maximum difference in glucose concentration per day over time. We compared ICU survivors and non-survivors and tested for effect-modification by pandemic wave 1 and 2, diabetes mellitus, and admission HbA1c. RESULTS Among 232 mechanically ventilated COVID-19 patients, 21.1% had known diabetes mellitus, whereas 16.9% in wave 2 had unknown diabetes mellitus. Non-survivors had higher mean glucose concentrations (ß 0.62 mmol/l; 95%CI 0.20-1.06; ß 11.2 mg/dl; 95% CI 3.6-19.1; P = 0.004) and higher maximum differences in glucose concentrations per day (ß 0.85 mmol/l; 95%CI 0.37-1.33; ß 15.3; 95%CI 6.7-23.9; P = 0.001). Effect modification by wave, history of diabetes mellitus and admission HbA1c in associations between glucose and survival was not present. Effect of higher mean glucose concentrations was modified by pandemic wave (wave 1 (ß 0.74; 95% CI 0.24-1.23 mmol/l) ; (ß 13.3; 95%CI 4.3-22.1 mg/dl)) vs. (wave 2 (ß 0.37 (95%CI 0.25-0.98) mmol/l) (ß 6.7 (95% ci 4.5-17.6) mg/dl)). CONCLUSIONS Hyperglycemia and glucose variability are associated with mortality in mechanically ventilated COVID-19 patients irrespective of the presence of diabetes mellitus.
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Affiliation(s)
- Thijs T W van Herpt
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
| | - Frank van Rosmalen
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Hendrica P M G Hulsewé
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Anouk N A van der Horst-Schrivers
- Department of Emergency Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Department of Endocrinology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Mariëlle Driessen
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Robin Jetten
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Noortje Zelis
- Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Bastiaan E de Galan
- Department of Endocrinology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Jacovides CL, Skeete DA, Werner NL, Toschlog EA, Agarwal S, Coopwood B, Crandall M, Tominaga GT. American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Consensus-Driven Protocol for glucose management in the post-resuscitation intensive care unit adult trauma patient. J Trauma Acute Care Surg 2023; 95:951-958. [PMID: 37561094 DOI: 10.1097/ta.0000000000004124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Christina L Jacovides
- From the Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery (C.L.J.), Temple University Hospital, Philadelphia, Pennsylvania; Division of Acute Care Surgery, Department of Surgery (D.A.S.), University of Iowa, Iowa City, Iowa; Department of Surgery (N.L.W.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin; Division of Trauma and Acute Care Surgery, Department of Surgery (E.A.T.), The Brody School of Medicine, East Carolina University, Greenville; Division of Trauma, Acute and Critical Care Surgery, Department of Surgery (S.A.), Duke University Medical Center, Durham, North Carolina; Trauma Services (B.C.), Poudre Valley Hospital, Fort Collins, Colorado; Department of Surgery (M.C.), University of Florida College of Medicine Jacksonville, Jacksonville, Florida; and Division of Trauma, Department of Surgery (G.T.M.), Scripps Memorial Hospital La Jolla, La Jolla, California
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Cheng J, Zhou Y, Zhang Z. Increased variability of the post-operative glucose level was a predictor of mortality for recipients after liver transplantation. Asian J Surg 2023; 46:5616-5618. [PMID: 37597986 DOI: 10.1016/j.asjsur.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/06/2023] [Indexed: 08/21/2023] Open
Affiliation(s)
- Jiangli Cheng
- Department of Respiratory Care, West China Hospital of Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, Sichuan, 610041, China.
| | - Yongfang Zhou
- Department of Respiratory Care, West China Hospital of Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, Sichuan, 610041, China.
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, Sichuan, 610041, China.
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Benyó B, Paláncz B, Szlávecz Á, Szabó B, Kovács K, Chase JG. Classification-based deep neural network vs mixture density network models for insulin sensitivity prediction problem. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107633. [PMID: 37343375 DOI: 10.1016/j.cmpb.2023.107633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
Model-based glycemic control (GC) protocols are used to treat stress-induced hyperglycaemia in intensive care units (ICUs). The STAR (Stochastic-TARgeted) glycemic control protocol - used in clinical practice in several ICUs in New Zealand, Hungary, Belgium, and Malaysia - is a model-based GC protocol using a patient-specific, model-based insulin sensitivity to describe the patient's actual state. Two neural network based methods are defined in this study to predict the patient's insulin sensitivity parameter: a classification deep neural network and a Mixture Density Network based method. Treatment data from three different patient cohorts are used to train the network models. Accuracy of neural network predictions are compared with the current model- based predictions used to guide care. The prediction accuracy was found to be the same or better than the reference. The authors suggest that these methods may be a promising alternative in model-based clinical treatment for patient state prediction. Still, more research is needed to validate these findings, including in-silico simulations and clinical validation trials.
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Affiliation(s)
- Balázs Benyó
- Department of Control Engineering and Information Technology, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Béla Paláncz
- Department of Control Engineering and Information Technology, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ákos Szlávecz
- Department of Control Engineering and Information Technology, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Bálint Szabó
- Department of Control Engineering and Information Technology, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Katalin Kovács
- Department of Informatics, Széchenyi István University, Győr, Hungary
| | - J Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
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11
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Tsai YH, Hung KY, Fang WF. Use of Peak Glucose Level and Peak Glycemic Gap in Mortality Risk Stratification in Critically Ill Patients with Sepsis and Prior Diabetes Mellitus of Different Body Mass Indexes. Nutrients 2023; 15:3973. [PMID: 37764757 PMCID: PMC10534504 DOI: 10.3390/nu15183973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Sepsis remains a critical concern in healthcare, and its management is complicated when patients have pre-existing diabetes and varying body mass indexes (BMIs). This retrospective multicenter observational study, encompassing data from 15,884 sepsis patients admitted between 2012 and 2017, investigates the relationship between peak glucose levels and peak glycemic gap in the first 3 days of ICU admission, and their impact on mortality. The study reveals that maintaining peak glucose levels between 141-220 mg/dL is associated with improved survival rates in sepsis patients with diabetes. Conversely, peak glycemic gaps exceeding 146 mg/dL are linked to poorer survival outcomes. Patients with peak glycemic gaps below -73 mg/dL also experience inferior survival rates. In terms of predicting mortality, modified Sequential Organ Failure Assessment-Peak Glycemic Gap (mSOFA-pgg) scores outperform traditional SOFA scores by 6.8% for 90-day mortality in overweight patients. Similarly, the modified SOFA-Peak Glucose (mSOFA-pg) score demonstrates a 17.2% improvement over the SOFA score for predicting 28-day mortality in underweight patients. Importantly, both mSOFA-pg and mSOFA-pgg scores exhibit superior predictive power compared to traditional SOFA scores for patients at high nutritional risk. These findings underscore the importance of glycemic control in sepsis management and highlight the potential utility of the mSOFA-pg and mSOFA-pgg scores in predicting mortality risk, especially in patients with diabetes and varying nutritional statuses.
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Affiliation(s)
- Yi-Hsuan Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.T.); (K.-Y.H.)
| | - Kai-Yin Hung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.T.); (K.-Y.H.)
- Department of Nutritional Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Department of Nursing, Mei Ho University, Pingtung 91202, Taiwan
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.T.); (K.-Y.H.)
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
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12
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Meng C, Zhang J, Wang Y, Ye X, Zhuang S. Association between time in range 70-180 mg/dl in early stage and severity with in patients acute pancreatitis. BMC Endocr Disord 2023; 23:159. [PMID: 37496012 PMCID: PMC10369797 DOI: 10.1186/s12902-023-01414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND It is not well understood whether glucose control in the early stage of acute pancreatitis(AP) is related to outcome. This study aimed to investigate the association between blood glucose time in range (TIR) of 70-180 mg/dL in the first 72 h(h) on admission and the progression of AP. METHODS Individuals admitted with AP to the Gastroenterology Department of the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University between January 2017 and December 2021 were included and retrospectively evaluated. The percentage of TIR between 70 and 180 mg/dL in the first 72 h was calculated. According to the progress of AP at discharge, patients were divided into mild pancreatitis(MAP), and moderately severe acute pancreatitis (MSAP), or severe acute pancreatitis (SAP) groups. We examined the association between TIR or TIR ≥ 70% and AP severity using logistic regression models stratified by a glycosylated hemoglobin (HbA1c) level of 6.5%. Receiver operating characteristic (ROC) curves were generated to assess the ability of the TIR to predict MSAP or SAP. RESULTS A total of 298 individuals were included, of whom 35 developed MSAP or SAP. Logistic regression analyses indicated that TIR was independently associated with the incidence of more serious AP (odds ratio [OR] = 0.962, 95% CI = 0.941-0.983, p = 0.001). This association remained significant in individuals with HbA1c levels ≤ 6.5% (OR = 0.928, 95% CI = 0.888-0.969, p = 0.001). A TIR ≥ 70% was independently associated with reduced severity only in people with well-antecedent controls (OR = 0.238; 95% CI = 0.071-0.802; p = 0.020). TIR was not powerful enough to predict the severity of AP in both patients with poor antecedent glucose control (AUC = 0.641) or with HbA1c < 6.5% (AUC = 0.668). CONCLUSIONS TIR was independently associated with severity in patients with AP, particularly those with good antecedent glucose control.
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Affiliation(s)
- Chuchen Meng
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Jie Zhang
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Ying Wang
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Xinhua Ye
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Shaohua Zhuang
- Department of Gastroenterology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, 29 Xinglong Road Changzhou, Jiangsu, 213000, China.
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13
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Zhou H, Segal E, Oyama LB. Editorial: Reviews in pharmacology of infectious diseases: 2022. Front Pharmacol 2023; 14:1236754. [PMID: 37521474 PMCID: PMC10374301 DOI: 10.3389/fphar.2023.1236754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Hong Zhou
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou, China
| | - Esther Segal
- Department of Microbiology and Clinical Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Boniface Oyama
- Institute of Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, United Kingdom
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14
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Canelli R, Louca J, Hartman C, Bilotta F. Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review. World J Diabetes 2023; 14:783-794. [PMID: 37383597 PMCID: PMC10294067 DOI: 10.4239/wjd.v14.i6.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/31/2023] [Accepted: 04/25/2023] [Indexed: 06/14/2023] Open
Abstract
The detrimental effects of both diabetes mellitus (DM) and hyperglycemia in the perioperative period are well established and have driven extensive efforts to control blood glucose concentration (BGC) in a variety of clinical settings. It is now appreciated that acute BGC spikes, hypoglycemia, and high glycemic variability (GV) lead to more endothelial dysfunction and oxidative stress than uncomplicated, chronically elevated BGC. In the perioperative setting, fasting is the primary approach to reducing the risk for pulmonary aspiration; however, prolonged fasting drives the body into a catabolic state and therefore may increase GV. Elevated GV in the perioperative period is associated with an increased risk for postoperative complications, including morbidity and mortality. These challenges pose a conundrum for the management of patients typically instructed to fast for at least 8 h before surgery. Preliminary evidence suggests that the administration of an oral preoperative carbohydrate load (PCL) to stimulate endogenous insulin production and reduce GV in the perioperative period may attenuate BGC spikes and ultimately decrease postoperative morbidity, without significantly increasing the risk of pulmonary aspiration. The aim of this scoping review is to summarize the available evidence on the impact of PCL on perioperative GV and surgical outcomes, with an emphasis on evidence pertaining to patients with DM. The clinical relevance of GV will be summarized, the relationship between GV and postoperative course will be explored, and the impact of PCL on GV and surgical outcomes will be presented. A total of 13 articles, presented in three sections, were chosen for inclusion. This scoping review concludes that the benefits of a PCL outweigh the risks in most patients, even in those with well controlled type 2 DM. The administration of a PCL might effectively minimize metabolic derangements such as GV and ultimately result in reduced postoperative morbidity and mortality, but this remains to be proven. Future efforts to standardize the content and timing of a PCL are needed. Ultimately, a rigorous data-driven consensus opinion regarding PCL administration that identifies optimal carbohydrate content, volume, and timing of ingestion should be established.
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Affiliation(s)
- Robert Canelli
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Joseph Louca
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Ciana Hartman
- Department of Anesthesiology, Boston Medical Center, Boston, MA 02118, United States
| | - Federico Bilotta
- Department of Anesthesiology, Sapienza University of Rome, Rome 00199, Italy
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15
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Sundarsingh V, Poddar B, Saran S, Jena SK, Azim A, Gurjar M, Singh RK, Baronia AK. Glucometrics in the first week of critical illness and its association with mortality. Med Intensiva 2023; 47:326-337. [PMID: 36344343 DOI: 10.1016/j.medine.2022.06.025] [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: 01/12/2022] [Accepted: 06/05/2022] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. DESIGN Prospective observational study. SETTING Mixed ICU of teaching hospital. PATIENTS Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180mg/dL. MAIN VARIABLES OF INTEREST Glucometrics calculated from the BG of first week of admission: hyperglycemia (BG>180mg/dL) and hypoglycemia (BG<70mg/dL) episodes; median, standard deviation (SD) and coefficient of variation (CV) of BG, glycemic lability index (GLI), time in target BG range (TIR). Factors influencing glucometrics and the association of glucometrics to patient outcomes analyzed. RESULTS A total of 5762 BG measurements in 100 patients of median age 55 years included. Glucometrics: hyperglycemia: 2253 (39%), hypoglycemia: 28 (0.48%), median BG: 169mg/dL (162-178.75), SD 31mg/dL (26-38.75), CV 18.6% (17.1-22.5), GLI: 718.5 [(mg/dL)2/h]/week (540.5-1131.5) and TIR 57% (50-67). Diabetes and higher APACHE II score were associated with higher SD and CV, and lower TIR. On multivariate regression, diabetes (p=0.009) and APACHE II score (p=0.016) were independently associated with higher SD. Higher SD and CV were associated with less vasopressor-free days; lower TIR with more blood-stream infections (BSI). Patients with higher SD, CV and GLI had a higher 28-day mortality. On multivariate analysis, GLI alone was associated with a higher mortality (OR 2.99, p=0.04). CONCLUSIONS Glycemic lability in the first week in ICU patients receiving insulin infusion is associated with higher mortality. Lower TIR is associated with more blood stream infections.
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Affiliation(s)
- V Sundarsingh
- Department of Critical Care Medicine, Father Muller Medical College Hospital, Mangalore, India
| | - B Poddar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - S Saran
- Department of Critical Care Medicine, King George Medical University, Lucknow, India
| | - S K Jena
- Department of Critical Care Medicine, Kalinga Institute of Medical Sciences, Bhuvaneswar, India
| | - A Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - M Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R K Singh
- Department of Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A K Baronia
- Government Medical College, Pithoragarh, India
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16
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Bao C, Deng F, Zhao S. Machine-learning models for prediction of sepsis patients mortality. Med Intensiva 2023; 47:315-325. [PMID: 36344339 DOI: 10.1016/j.medine.2022.06.024] [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: 03/01/2022] [Accepted: 06/07/2022] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Sepsis is an infection-caused syndrome, that leads to life-threatening organ damage. We aim to develop machine learning models with large-scale data to predict sepsis patients' mortality. DESIGN we extracted sepsis patients from two databases, Medical Information Mart for Intensive Care IV (MIMIC-IV) as a train set and Philips eICU Collaborative Research Database as a test set. SETTING ICUs in multicenter hospitals in the USA during 2012-2019. PATIENTS OR PARTICIPANTS A total of 21,680 sepsis-3 patients are included in the study, in which, 3771 patients were dead and 17,909 survived during hospitalization, respectively. INTERVENTIONS No interventions. MAIN VARIABLES OF INTEREST Basic information, examination items during hospitalization and some medication and treatment information are incorporated into analyzed. Seven different models were built with a Support vector machine, Decision Tree Classifier, Random Forest, Gradients Boosting, Multiple Layer Perception, Xgboost, light Gradients Boosting to predict dead or live during hospitalization. RESULTS Algorithms with an AUC value in the test set of the top three: light GBM, GBM, Xgboost. Considering the performance of the training set and the test set, the light GBM model performs best, and then the parameters of the model were adjusted, after that the AUC value was 0.99 in the train set, 0.96 in the test set, respectively. CONCLUSIONS Models built with light GBM algorithm from real-world sepsis patients from electronic health records accurately predict whether sepsis patients are dead and can be incorporated into clinical decision tools to enhance the prognosis of the patient and prevent adverse outcomes.
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Affiliation(s)
- C Bao
- Xiangya Hospital, Department of Critical Care Medicine & National Clinical Research Center for Geriatric Disorders, Central South University, Hainan General Hospital, Department of Emergency, Hainan Medical University, Haikou, Hainan, China
| | - F Deng
- Xiangya Hospital, Department of Oncology, Central South University, Changsha, China
| | - S Zhao
- Xiangya Hospital, Department of Critical Care Medicine & National Clinical Research Center for Geriatric Disorders, Central South University, Hunan Intensive Care Medicine Research Centre, China.
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17
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Tao L, Zhu Y, Liu J. Identification of new co-diagnostic genes for sepsis and metabolic syndrome using single-cell data analysis and machine learning algorithms. Front Genet 2023; 14:1129476. [PMID: 37007944 PMCID: PMC10060809 DOI: 10.3389/fgene.2023.1129476] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
Sepsis, a serious inflammatory response that can be fatal, has a poorly understood pathophysiology. The Metabolic syndrome (MetS), however, is associated with many cardiometabolic risk factors, many of which are highly prevalent in adults. It has been suggested that Sepsis may be associated with MetS in several studies. Therefore, this study investigated diagnostic genes and metabolic pathways associated with both diseases. In addition to microarray data for Sepsis, PBMC single cell RNA sequencing data for Sepsis and microarray data for MetS were downloaded from the GEO database. Limma differential analysis identified 122 upregulated genes and 90 downregulated genes in Sepsis and MetS. WGCNA identified brown co-expression modules as Sepsis and MetS core modules. Two machine learning algorithms, RF and LASSO, were used to screen seven candidate genes, namely, STOM, BATF, CASP4, MAP3K14, MT1F, CFLAR and UROD, all with an AUC greater than 0.9. XGBoost assessed the co-diagnostic efficacy of Hub genes in Sepsis and MetS. The immune infiltration results show that Hub genes were expressed at high levels in all immune cells. After performing Seurat analysis on PBMC from normal and Sepsis patients, six immune subpopulations were identified. The metabolic pathways of each cell were scored and visualized using ssGSEA, and the results show that CFLAR plays an important role in the glycolytic pathway. Our study identified seven Hub genes that serve as co-diagnostic markers for Sepsis and MetS and revealed that diagnostic genes play an important role in immune cell metabolic pathway.
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Affiliation(s)
- Linfeng Tao
- Department of Critical Care Medicine, Suzhou Municipal Hospital, Suzhou Clinical Medical Center of Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou, China
| | - Yue Zhu
- Department of Breast and Thyroid Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, China
| | - Jun Liu
- Department of Critical Care Medicine, Suzhou Municipal Hospital, Suzhou Clinical Medical Center of Critical Care Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou, China
- *Correspondence: Jun Liu,
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18
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Peng Z, Song J, Li L, Guo C, Yang J, Kong W, Huang J, Hu J, Liu S, Tian Y, Yang D, Li F, Zi W, Xie D, Yang Q. Association between stress hyperglycemia and outcomes in patients with acute ischemic stroke due to large vessel occlusion. CNS Neurosci Ther 2023. [PMID: 36914967 DOI: 10.1111/cns.14163] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/08/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
AIMS This study aimed to evaluate the association between stress hyperglycemia ratio (SHR) and clinical outcomes at 90 days in acute ischemic stroke due to large vessel occlusion receiving endovascular treatment. METHODS The RESCUE BT trial was a multicenter, randomized, double-blind, placebo-controlled clinical trial, consisting of 948 stroke patients from 55 centers in China. A total of 542 patients with glucose and glycated hemoglobin (HbA1C) values at admission were included in this analysis. SHR, measured by glucose/HbA1C, was evaluated as both a tri-categorical variable (≤1.07 vs. 1.08-1.29 vs. ≥1.30) and a continuous variable. The primary outcome was a favorable functional outcome (modified Rankin Scale [mRS] score ≤2) at 90 days. The secondary outcome included excellent functional outcome (mRS score ≤1) and safety outcomes, such as 90-day mortality and intracranial hemorrhage. The study was registered with Chictr.org.cn (ChiCTR-INR-17014167). RESULTS Compared with patients in the lowest tertile of SHR, the highest tertile group had significantly lower odds of achieving favorable functional outcome of mRS score of 0-2 (adjusted odds ratio, 0.44; 95% confidence interval, 0.28-0.69; p < 0.001) and excellent clinical outcome of mRS score of 0-1 (adjusted odds ratio, 0.48; 95% confidence interval, 0.29-0.79; p = 0.004) at 90 days after adjusting for potential covariates. Similar results were observed after further adjustment for preexisting diabetes and Alberta Stroke Program Early Computed Tomography Score (ASPECTS). CONCLUSION Stress hyperglycemia ratio, as measured by the glucose/HbA1C, was associated with a decreased odds of achieving a favorable functional outcome in patients with acute large vessel occlusion stroke at 90 days.
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Affiliation(s)
- Zhouzhou Peng
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Linyu Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jie Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Weilin Kong
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jiacheng Huang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jinrong Hu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yan Tian
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Dahong Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Dongjing Xie
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
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19
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McDonnell ME, Garg R, Gopalakrishnan G, Mitri J, Weinstock RS, Greenfield M, Katta S, Lebastchi J, Palermo NE, Radhakrishnan R, Westcott GP, Johnson M, Simonson DC. Glycemic Gap Predicts Mortality in a Large Multicenter Cohort Hospitalized With COVID-19. J Clin Endocrinol Metab 2023; 108:718-725. [PMID: 36217580 PMCID: PMC9619706 DOI: 10.1210/clinem/dgac587] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Diabetes or hyperglycemia at admission are established risk factors for adverse outcomes during hospitalization for COVID-19, but the impact of prior glycemic control is not clear. OBJECTIVE We aimed to examine the associations between admission variables, including glycemic gap, and adverse clinical outcomes in patients hospitalized with COVID-19 infection. METHODS We examined the relationship between clinical predictors, including acute and chronic glycemia, and clinical outcomes, including intensive care unit (ICU) admission, mechanical ventilation (MV), and mortality among 1786 individuals with diabetes or hyperglycemia (glucose > 10 mmol/L twice in 24 hours) who were admitted from March 2020 through February 2021 with COVID-19 infection at 5 university hospitals in the eastern United States. RESULTS The cohort was 51.3% male, 53.3% White, 18.8% Black, 29.0% Hispanic, with age = 65.6 ± 14.4 years, BMI = 31.5 ± 7.9 kg/m2, glucose = 12.0 ± 7.5 mmol/L [216 ± 135 mg/dL], and HbA1c = 8.07% ± 2.25%. During hospitalization, 38.9% were admitted to the ICU, 22.9% received MV, and 10.6% died. Age (P < 0.001) and admission glucose (P = 0.014) but not HbA1c were associated with increased risk of mortality. Glycemic gap, defined as admission glucose minus estimated average glucose based on HbA1c, was a stronger predictor of mortality than either admission glucose or HbA1c alone (OR = 1.040 [95% CI: 1.019, 1.061] per mmol/L, P < 0.001). In an adjusted multivariable model, glycemic gap, age, BMI, and diabetic ketoacidosis on admission were associated with increased mortality, while higher estimated glomerular filtration rate (eGFR) and use of any diabetes medication were associated with lower mortality (P < 0.001). CONCLUSION Relative hyperglycemia, as measured by the admission glycemic gap, is an important marker of mortality risk in COVID-19.
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Affiliation(s)
- Marie E McDonnell
- Corresponding Author: Marie E. McDonnell, M.D. Division of Endocrinology, Diabetes and Hypertension Brigham and Women’s Hospital 221 Longwood Avenue Boston, MA 02115 E-mail: phone: 617-732-5693
| | - Rajesh Garg
- University of Miami, Miller School of Medicine, Miami, FL
| | - Geetha Gopalakrishnan
- Rhode Island Hospital, Providence, RI
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Joanna Mitri
- Harvard Medical School, Boston, MA
- Joslin Diabetes Center, Boston, MA
- Beth Israel-Deaconess Medical Center, Boston, MA
| | - Ruth S Weinstock
- State University of New York Upstate Medical University, Syracuse, NY
| | | | - Sai Katta
- State University of New York Upstate Medical University, Syracuse, NY
| | - Jasmin Lebastchi
- Rhode Island Hospital, Providence, RI
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Nadine E Palermo
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Gregory P Westcott
- Harvard Medical School, Boston, MA
- Beth Israel-Deaconess Medical Center, Boston, MA
| | | | - Donald C Simonson
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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20
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Mårtensson J, Cutuli S, Yanase F, Ancona P, Toh L, Osawa E, Bellomo R. Glycemic control and blood gas sampling frequency during continuous glucose monitoring in the intensive care unit: A before-and-after study. Acta Anaesthesiol Scand 2023; 67:86-93. [PMID: 36263915 PMCID: PMC10092568 DOI: 10.1111/aas.14159] [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: 05/07/2022] [Revised: 08/21/2022] [Accepted: 10/16/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Whether subcutaneous continuous glucose monitoring (CGM) can safely replace intermittent arterial blood gas glucose analyses in intensive care unit (ICU) patients remains uncertain. We aimed to compare CGM to blood gas glucose values and assess whether CGM use reduces blood gas sampling frequency and glucose variability in ICU patients with type 2 diabetes managed with liberal glucose control. METHODS We used the FreeStyle Libre CGM in 15 ICU patients and compared their blood glucose metrics with a pre-CGM control population of 105 ICU patients with type 2 diabetes. Both groups received insulin to target glucose range of 10-14 mmol/L. We used linear regression analysis adjusted for illness severity to assess the association of CGM use with blood gas sampling frequency and glucose variability. We used mean absolute relative difference (MARD) and Clarke error grid analysis to assess accuracy of matched CGM-blood glucose values overall, across glucose stata (<10, 10-14, >14 mmol/L), and over time (≤48, 48-96, >96 h). RESULTS We analyzed 483 matched glucose values. Overall MARD was 11.5 (95% CI, 10.7-12.3)% with 99% of readings in Clarke zones A and B. MARD was 15.5% for glucose values <10 mmol/L, 11.1% at 10-14 mmol/L, and 11.4% >14 mmol/L. MARD was 13.8% in the first 48 h, 10.9% at 48-96 h, and 8.9% beyond 96 h. CGM use was associated with 30% reduction in blood gas sampling frequency. CGM use was not associated with glucose variability as determined by glycemic lability index or standard deviation of blood glucose. CONCLUSIONS In our cohort of ICU patients with type 2 diabetes receiving liberal glycemic control, CGM showed acceptable accuracy and was associated with a reduction in blood gas sampling frequency without compromising glucose control. Lowest accuracy was observed at glucose values below 10 mmol/L and during the first 48 h of CGM use.
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Affiliation(s)
- Johan Mårtensson
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Salvatore Cutuli
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Paolo Ancona
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Lisa Toh
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Eduardo Osawa
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Data Analytics Research and Evaluation Center, Austin Hospital, Melbourne, Victoria, Australia.,Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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21
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Královcová M, Karvunidis T, Matějovič M. Critical care for multimorbid patients. VNITRNI LEKARSTVI 2023; 69:166-172. [PMID: 37468311 DOI: 10.36290/vnl.2023.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Multimorbidity - the simultaneous presence of several chronic diseases - is very common in the critically ill patients. Its prevalence is roughly 40-85 % and continues to increase further. Certain chronic diseases such as diabetes, obesity, chronic heart, pulmonary, liver or kidney disease and malignancy are associated with higher risk of developing serious acute complications and therefore the possible need for intensive care. This review summarizes and discusses selected specifics of critical care for multimorbid patients.
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22
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Liu D, Fan Y, Zhuang Y, Peng H, Gao C, Chen Y. Association of Blood Glucose Variability with Sepsis-Related Disseminated Intravascular Coagulation Morbidity and Mortality. J Inflamm Res 2022; 15:6505-6516. [DOI: 10.2147/jir.s383053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
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23
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Bao C, Deng F, Zhao S. Machine-learning models for prediction of sepsis patients mortality. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Sundarsingh V, Poddar B, Saran S, Jena S, Azim A, Gurjar M, Singh R, Baronia A. Glucometrics in the first week of critical illness and its association with mortality. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Vedantam D, Poman DS, Motwani L, Asif N, Patel A, Anne KK. Stress-Induced Hyperglycemia: Consequences and Management. Cureus 2022; 14:e26714. [PMID: 35959169 PMCID: PMC9360912 DOI: 10.7759/cureus.26714] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 01/08/2023] Open
Abstract
Hyperglycemia during stress is a common occurrence seen in patients admitted to the hospital. It is defined as a blood glucose level above 180mg/dl in patients without pre-existing diabetes. Stress-induced hyperglycemia (SIH) occurs due to an illness that leads to insulin resistance and decreased insulin secretion. Such a mechanism causes elevated blood glucose and produces a complex state to manage with external insulin. This article compiles various studies to explain the development and consequences of SIH in the critically ill that ultimately lead to an increase in mortality while also discussing the dire impact of SIH on certain acute illnesses like myocardial infarction and ischemic stroke. It also evaluates multiple studies to understand the management of SIH with insulin and proper nutritional therapy in the hospitalized patients admitted to the Intensive care unit (ICU) alongside the non-critical care unit. While emphasizing the diverse effects of improper control of SIH in the hospital, this article elucidates and discusses the importance of formulating a discharge plan due to an increased risk of type 2 diabetes in the recovered.
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Affiliation(s)
- Deepanjali Vedantam
- Internal Medicine, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, IND
| | | | - Lakshya Motwani
- Research and Development, Smt. NHL (Nathiba Hargovandas Lakhmichand) Municipal Medical College, Ahmedabad, IND
| | - Nailah Asif
- Research, RAK (Ras Al Khaimah) College of Medical Sciences, Ras Al Khaimah, ARE
| | - Apurva Patel
- Research, GMERS (Gujarat Medical Education & Research Society) Gotri Medical College, Vadodara, IND
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26
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Kosyakovsky LB, Somerset E, Rogers AJ, Sklar M, Mayers JR, Toma A, Szekely Y, Soussi S, Wang B, Fan CPS, Baron RM, Lawler PR. Machine learning approaches to the human metabolome in sepsis identify metabolic links with survival. Intensive Care Med Exp 2022; 10:24. [PMID: 35710638 PMCID: PMC9203139 DOI: 10.1186/s40635-022-00445-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/03/2022] [Indexed: 12/29/2022] Open
Abstract
Background Metabolic predictors and potential mediators of survival in sepsis have been incompletely characterized. We examined whether machine learning (ML) tools applied to the human plasma metabolome could consistently identify and prioritize metabolites implicated in sepsis survivorship, and whether these methods improved upon conventional statistical approaches. Methods Plasma gas chromatography–liquid chromatography mass spectrometry quantified 411 metabolites measured ≤ 72 h of ICU admission in 60 patients with sepsis at a single center (Brigham and Women’s Hospital, Boston, USA). Seven ML approaches were trained to differentiate survivors from non-survivors. Model performance predicting 28 day mortality was assessed through internal cross-validation, and innate top-feature (metabolite) selection and rankings were compared across the 7 ML approaches and with conventional statistical methods (logistic regression). Metabolites were consensus ranked by a summary, ensemble ML ranking procedure weighing their contribution to mortality risk prediction across multiple ML models. Results Median (IQR) patient age was 58 (47, 62) years, 45% were women, and median (IQR) SOFA score was 9 (6, 12). Mortality at 28 days was 42%. The models’ specificity ranged from 0.619 to 0.821. Partial least squares regression-discriminant analysis and nearest shrunken centroids prioritized the greatest number of metabolites identified by at least one other method. Penalized logistic regression demonstrated top-feature results that were consistent with many ML methods. Across the plasma metabolome, the 13 metabolites with the strongest linkage to mortality defined through an ensemble ML importance score included lactate, bilirubin, kynurenine, glycochenodeoxycholate, phenylalanine, and others. Four of these top 13 metabolites (3-hydroxyisobutyrate, indoleacetate, fucose, and glycolithocholate sulfate) have not been previously associated with sepsis survival. Many of the prioritized metabolites are constituents of the tryptophan, pyruvate, phenylalanine, pentose phosphate, and bile acid pathways. Conclusions We identified metabolites linked with sepsis survival, some confirming prior observations, and others representing new associations. The application of ensemble ML feature-ranking tools to metabolomic data may represent a promising statistical platform to support biologic target discovery. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-022-00445-8.
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Affiliation(s)
- Leah B Kosyakovsky
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Emily Somerset
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Rogers Computational Program, Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - Angela J Rogers
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
| | - Jared R Mayers
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Augustin Toma
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Yishay Szekely
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Division of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sabri Soussi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Bo Wang
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Vector Institute for Artificial Intelligence, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Chun-Po S Fan
- Rogers Computational Program, Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Canada
| | - Rebecca M Baron
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada. .,Department of Medicine, University of Toronto, Toronto, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. .,Peter Munk Cardiac Center, Toronto General Hospital, RFE3-410, 190 Elizabeth St., Toronto, ON, M5G 2C4, Canada.
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27
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Kang Y, Tang D, Lan L, Zhou H. Editorial: Sepsis: Basic, Clinical and Therapeutic Approaches. Front Pharmacol 2022; 13:910332. [PMID: 35645807 PMCID: PMC9131450 DOI: 10.3389/fphar.2022.910332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yan Kang
- Department of Critical Care Medicine, Institute of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China Tianfu Hospital, Sichuan Universities, Chengdu, China
| | - Daolin Tang
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Lefu Lan
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Pudong Zhangjiang Hi-Tech Park, Shanghai, China
| | - Hong Zhou
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
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28
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Lu Z, Tao G, Sun X, Zhang Y, Jiang M, Liu Y, Ling M, Zhang J, Xiao W, Hua T, Zhu H, Yang M. Association of Blood Glucose Level and Glycemic Variability With Mortality in Sepsis Patients During ICU Hospitalization. Front Public Health 2022; 10:857368. [PMID: 35570924 PMCID: PMC9099235 DOI: 10.3389/fpubh.2022.857368] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/25/2022] [Indexed: 01/13/2023] Open
Abstract
Background There was considerable debate regarding the effect of mean blood glucose (MBG) and glycemic variability (GV) on the mortality of septic patients. This retrospective cohort study aimed to assess the association between MBG and GV with ICU mortality of sepsis patients and to explore the optimal MBG range. Methods Sepsis patients were enrolled from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). MBG and glycemic coefficient of variation (GluCV) were, respectively, calculated to represent the overall glycemic status and GV during ICU stay. The associations between MBG, GluCV, and ICU mortality of the septic patients were assessed by using multivariate logistic regression in different subgroups and the severity of sepsis. Restricted cubic splines evaluated the optimal MBG target. Results A total of 7,104 adult sepsis patients were included. The multivariate logistic regression results showed that increased MBG and GluCV were significantly correlated with ICU mortality. The adjusted odds ratios were 1.14 (95% CI 1.09-1.20) and 1.05 (95% CI 1.00-1.12). However, there was no association between hyperglycemia and ICU mortality among diabetes, liver disease, immunosuppression, and hypoglycemia patients. And the impact of high GluCV on ICU mortality was not observed in those with diabetes, immunosuppression, liver disease, and non-septic shock. The ICU mortality risk of severe hyperglycemia (≧200 mg/dl) and high GluCV (>31.429%), respectively, elevated 2.30, 3.15, 3.06, and 2.37, 2.79, 3.14-folds in mild (SOFA ≦ 3), middle (SOFA 3-7), and severe group (SOFA ≧ 7). The MBG level was associated with the lowest risk of ICU mortality and hypoglycemia between 120 and 140 mg/dl in the subgroup without diabetes. For the diabetic subset, the incidence of hypoglycemia was significantly reduced when the MBG was 140-190 mg/dl, but a glycemic control target effectively reducing ICU mortality was not observed. Conclusion MBG and GluCV during the ICU stay were associated with all-cause ICU mortality in sepsis patients; however, their harms are not apparent in some particular subgroups. The impact of hyperglycemia and high GV on death increased with the severity of sepsis. The risk of ICU mortality and hypoglycemia in those with no pre-existing diabetes was lower when maintaining the MBG in the range of 120-140 mg/dl.
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Affiliation(s)
- Zongqing Lu
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Gan Tao
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoyu Sun
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yijun Zhang
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mengke Jiang
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Liu
- Key Laboratory of Intelligent Computing and Signal Processing, Anhui University, Ministry of Education, Hefei, China
| | - Meng Ling
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jin Zhang
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenyan Xiao
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianfeng Hua
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huaqing Zhu
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University, Hefei, China
| | - Min Yang
- The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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29
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Li X, Zhang D, Chen Y, Ye W, Wu S, Lou L, Zhu Y. Acute glycemic variability and risk of mortality in patients with sepsis: a meta-analysis. Diabetol Metab Syndr 2022; 14:59. [PMID: 35461267 PMCID: PMC9034073 DOI: 10.1186/s13098-022-00819-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute glycemic variability (GV) has been correlated with the severity of sepsis. The aim of the study was to evaluate the potential association between acute GV and mortality risk in patients with sepsis. METHODS Cohort studies comparing the risk of death within 3 months between septic patients with higher versus lower acute GV were retrieved by systematic search of Medline, Embase, Web of Science, Wanfang and CNKI databases. We used a random-effect model to pool the data by incorporating the between-study heterogeneity. Sensitivity analyses were performed to evaluate the stability of the findings. RESULTS Ten studies including 4296 patients were available for the meta-analysis. Pooled results showed that septic patients with higher acute GV had significantly increased mortality risk compared to those with lower acute GV, as evidenced by results using different parameters including standard deviation of blood glucose (SDBG, risk ratio [RR]: 1.74, 95% confidence interval [CI] 1.36-2.24, p < 0.001; I2 = 0%), coefficient of variation of blood glucose (RR: 1.91, 95% CI 1.57-2.31, p < 0.001; I2 = 0%), mean amplitude of glycemic excursion (RR: 1.81. 95% CI 1.36-2.40, p < 0.001; I2 = 0%), and glycemic lability index (RR: 2.52, 95% CI 1.72-3.68, p < 0.001; I2 = 0%). Sensitivity analyses by excluding one study at a time did not significantly affect the results (p all < 0.05). CONCLUSIONS Higher acute GV may be a predictor of mortality risk in patients with sepsis.
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Affiliation(s)
- Xiaofei Li
- Department of Infectious Diseases, Yiwu Central Hospital, No. 519 Nanmen Street, Yiwu, 322000, Zhejiang, China.
| | - Daofu Zhang
- Department of Intensive Care Unit, Liaocheng Daochangfu People's Hospital, Liaocheng, 252000, China
| | - Yongxin Chen
- Department of Infectious Diseases, Yiwu Central Hospital, No. 519 Nanmen Street, Yiwu, 322000, Zhejiang, China
| | - Weiwei Ye
- Department of Infectious Diseases, Yiwu Central Hospital, No. 519 Nanmen Street, Yiwu, 322000, Zhejiang, China
| | - Shuang Wu
- Department of Infectious Diseases, Yiwu Central Hospital, No. 519 Nanmen Street, Yiwu, 322000, Zhejiang, China
| | - Lianqing Lou
- Department of Infectious Diseases, Yiwu Central Hospital, No. 519 Nanmen Street, Yiwu, 322000, Zhejiang, China
| | - Yanshuang Zhu
- Department of Infectious Diseases, Yiwu Central Hospital, No. 519 Nanmen Street, Yiwu, 322000, Zhejiang, China
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30
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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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Kingren MS, Starr ME, Saito H. Divergent Sepsis Pathophysiology in Older Adults. Antioxid Redox Signal 2021; 35:1358-1375. [PMID: 34210173 PMCID: PMC8905233 DOI: 10.1089/ars.2021.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 12/12/2022]
Abstract
Significance: Both incidence and mortality rates of sepsis significantly increase with advanced age, and the majority of sepsis patients are late middle-aged or older. With the proportion of older adults rapidly increasing in developed countries, age-dependent sepsis vulnerability is an urgent medical issue. Due to an increasing life expectancy, postsepsis complications and health care costs are expected to increase as well. Recent Advances: Older patients suffer from higher sepsis incidence and mortality rates, likely resulting from frequent comorbidities, increased coagulation, dysgylcemia, and altered immune responses. Critical Issues: Despite a large number of ongoing clinical and basic research studies, there is currently no effective therapeutic strategy targeting older patients with severe sepsis. The disparity between clinical and basic studies is a problem, and this is largely due to the use of animal models lacking clinical relevance. Although the majority of sepsis cases occur in older adults, most laboratory animals used for sepsis research are very young. Further, despite the wide use of combination fluid and antibiotic treatment in intensive care unit (ICU) patients, most animal research does not include such treatment. Future Directions: Because sepsis is a systemic disease with multiple organ dysfunction, combined therapy approaches, not those targeting single pathways or single organs, are essential. As for preclinical research, it is critical to confirm new findings using aged animal models with clinically relevant ICU-like medical treatments. Antioxid. Redox Signal. 35, 1358-1375.
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Affiliation(s)
- Meagan S. Kingren
- Aging and Critical Care Research Laboratory, Departments of University of Kentucky, Lexington, Kentucky, USA
- Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Marlene E. Starr
- Aging and Critical Care Research Laboratory, Departments of University of Kentucky, Lexington, Kentucky, USA
- Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
- Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Hiroshi Saito
- Aging and Critical Care Research Laboratory, Departments of University of Kentucky, Lexington, Kentucky, USA
- Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
- Surgery, University of Kentucky, Lexington, Kentucky, USA
- Physiology, University of Kentucky, Lexington, Kentucky, USA
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Qureshi AI, Huang W, Lobanova I, Chandrasekaran PN, Hanley DF, Hsu CY, Martin RH, Steiner T, Suarez JI, Yamamoto H, Toyoda K. Effect of Moderate and Severe Persistent Hyperglycemia on Outcomes in Patients With Intracerebral Hemorrhage. Stroke 2021; 53:1226-1234. [PMID: 34844422 DOI: 10.1161/strokeaha.121.034928] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE We evaluated the effect of persistent hyperglycemia on outcomes in 1000 patients with intracerebral hemorrhage enrolled within 4.5 hours of symptom onset. METHODS We defined moderate and severe hyperglycemia based on serum glucose levels ≥140 mg/dL-<180 and ≥180 mg/dL, respectively, measured at baseline, 24, 48, and 72 hours. Persistent hyperglycemia was defined by 2 consecutive (24 hours apart) serum glucose levels. We evaluated the relationship between moderate and severe hyperglycemia and death or disability (defined by modified Rankin Scale score of 4-6) at 90 days in the overall cohort and in groups defined by preexisting diabetes. RESULTS In the multivariate analysis, both moderate (odds ratio, 1.8 [95% CI, 1.1-2.8]) and severe (odds ratio, 1.8 [95% CI, 1.2-2.7]) hyperglycemia were associated with higher 90-day death or disability after adjusting for Glasgow Coma Scale score, hematoma volume, presence or absence of intraventricular hemorrhage, hyperlipidemia, cigarette smoking, and hypertension (no interaction between hyperglycemia and preexisting diabetes, P=0.996). Among the patients without preexisting diabetes, both moderate (odds ratio, 1.8 [95% CI, 1.0-3.2]) and severe (odds ratio, 2.0 [95% CI, 1.1-3.7]) hyperglycemia were associated with 90-day death or disability after adjusting for above mentioned potential confounders. Among the patients with preexisting diabetes, moderate and severe hyperglycemia were not associated with 90-day death or disability. CONCLUSIONS Persistent hyperglycemia, either moderate or severe, increased the risk of death or disability in nondiabetic patients with intracerebral hemorrhage. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01176565.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, St Cloud, MN (A.I.Q., W.H., I.L.).,Department of Neurology, University of Missouri, Columbia (A.I.Q., W.H., I.L., P.N.C.)
| | - Wei Huang
- Zeenat Qureshi Stroke Institute, St Cloud, MN (A.I.Q., W.H., I.L.).,Department of Neurology, University of Missouri, Columbia (A.I.Q., W.H., I.L., P.N.C.)
| | - Iryna Lobanova
- Zeenat Qureshi Stroke Institute, St Cloud, MN (A.I.Q., W.H., I.L.).,Department of Neurology, University of Missouri, Columbia (A.I.Q., W.H., I.L., P.N.C.)
| | | | - Daniel F Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD. (D.F.H.)
| | - Chung Y Hsu
- Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan (C.Y.H.)
| | - Renee H Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (R.H.M.)
| | - Thorsten Steiner
- Department of Neurology, University of Heidelberg, Germany (T.S.)
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. (J.I.S.)
| | - Haruko Yamamoto
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan. (H.Y.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. (K.T.)
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Hasegawa D, Sato R, Prasitlumkum N, Nishida K. Effect of Premorbid Beta-Blockers on Mortality in Patients With Sepsis: A Systematic Review and Meta-Analysis. J Intensive Care Med 2021; 37:908-916. [PMID: 34812680 DOI: 10.1177/08850666211052926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to conduct a systematic review and meta-analysis to investigate the impact of premorbid beta-blockers on mortality in patients with sepsis. DATA SOURCES We searched EMBASE, the Cochrane Central Register of Controlled Trials, and MEDLINE for eligible studies. The protocol was registered at the PROSPERO (CRD42021256813). STUDY SELECTION Two authors independently evaluated the following inclusion criteria: (1) randomized controlled trials, cohort studies, cross-sectional studies; (2) patients with sepsis aged ≥18 years, and (3) premorbid beta-blocker use. DATA EXTRACTION Two authors extracted the patients' characteristics and outcomes independently. All analyses were performed using the random-effects models. The primary outcome was short-term mortality, defined as mortality within 30 days, in-hospital or intensive care unit mortality. DATA SYNTHESIS Ten studies (n = 24 748 patients) were included. The pooled odds ratio (OR) of short-term mortality associated with the premorbid use of beta-blockers was 0.85 (95% confidence interval [CI], 0.69-1.04; P = .12; I2 = 50%). Five studies reported an adjusted OR of short-term mortality. The pooled adjusted OR of short-term mortality associated with the premorbid use of beta-blockers was 0.73 (95% CI, 0.65-0.83; P < .001; I2 = 0%). CONCLUSION Premorbid beta-blockers were associated with a lower short-term mortality in patients with sepsis.
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Affiliation(s)
- Daisuke Hasegawa
- 22524Mount Sinai Beth Israel, NY, USA.,Anesthesiology and Critical Care Medicine, 2569Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryota Sato
- Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | | | - Kazuki Nishida
- 36589Nagoya University Graduate School of Medicine, Aichi, Japan
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Sun MT, Li IC, Lin WS, Lin GM. Pros and cons of continuous glucose monitoring in the intensive care unit. World J Clin Cases 2021; 9:8666-8670. [PMID: 34734045 PMCID: PMC8546806 DOI: 10.12998/wjcc.v9.i29.8666] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/19/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus affects people worldwide, and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients. Previous reports have confirmed that hyperglycemia can increase the risk of mortality in patients cared in the intensive care unit (ICU). In addition, severe and multiple hypoglycemia increases the risk of mortality when using insulin or intensive antidiabetic therapy. The innovation of continuous glucose monitoring (CGM) may help to alert medical caregivers with regard to the development of hyperglycemia and hypoglycemia, which may decrease the potential complications in patients in the ICU. The major limitation of CGM is the measurement of interstitial glucose levels rather than real-time blood glucose levels; thus, there will be a delay in the treatment of hyperglycemia and hypoglycemia in patients. Recently, the European Union approved a state-of-art artificial intelligence directed loop system coordinated by CGM and a continuous insulin pump for diabetes control, which may provide a practical way to prevent acute adverse glycemic events related to antidiabetic therapy in critically ill patients. In this mini-review paper, we describe the application of CGM to patients in the ICU and summarize the pros and cons of CGM.
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Affiliation(s)
- Ming-Tsung Sun
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien 971, Taiwan
| | - I-Cheng Li
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien 971, Taiwan
| | - Wei-Shiang Lin
- Department of Medicine, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien 971, Taiwan
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Hanna M, Balintescu A, Glassford N, Lipcsey M, Eastwood G, Oldner A, Bellomo R, Mårtensson J. Glycemic lability index and mortality in critically ill patients-A multicenter cohort study. Acta Anaesthesiol Scand 2021; 65:1267-1275. [PMID: 33964015 DOI: 10.1111/aas.13843] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Emerging evidence indicates a relationship between glycemic variability during intensive care unit (ICU) admission and death. We assessed whether mean glucose, hypoglycemia occurrence, or premorbid glycemic control modified this relationship. METHODS In this retrospective, multicenter cohort study, we included adult patients admitted to five ICUs in Australia and Sweden with available preadmission glycated hemoglobin A1c (HbA1c) and three or more glucose readings. We calculated the glycemic lability index (GLI), a measure of glycemic variability, and the time-weighted average blood glucose (TWA-BG) from all glucose readings. We used logistic regression analysis with adjustment for hypoglycemia and admission characteristics to assess the independent association of GLI (above vs. below cohort median) and TWA-BG (above vs. below cohort median) with hospital mortality. RESULTS Among 2305 patients, 859 (37%) had diabetes, median GLI was 40 [mmol/L]2 /h/week, median TWA-BG was 8.2 mmol/L, 171 (7%) developed hypoglycemia, and 371 (16%) died. The adjusted odds ratio for death was 1.61 (95% CI, 1.19-2.15; P = .002) for GLI above versus below median and 1.06 (95% CI, 0.80-1.41; P = .67) for TWA-BG above versus below median. The relationship between GLI and mortality was not modified by TWA-BG (P [interaction] = 0.66), a history of diabetes (P [interaction] = 0.89) or by HbA1c ≥52 mmol/mol (vs. <52 mmol/mol) (P [interaction] = 0.29). CONCLUSION In adult patients admitted to an ICU in Sweden and Australia, a high GLI was associated with increased hospital mortality irrespective of the level of mean glycemia, hypoglycemia occurrence, or premorbid glycemic control. These findings support the assessment of interventions to reduce glycemic variability during critical illness.
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Affiliation(s)
- Michel Hanna
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - Anca Balintescu
- Department of Clinical Science and Education Södersjukhuset Section of Anaesthesia and Intensive Care Karolinska Institutet Stockholm Sweden
| | - Neil Glassford
- Department of Intensive Care Austin Hospital Melbourne Australia
| | - Miklos Lipcsey
- Hedenstierna Laboratory Department of Surgical Sciences Section of Anaesthesiology and Intensive care Uppsala University Uppsala Sweden
| | - Glenn Eastwood
- Department of Intensive Care Austin Hospital Melbourne Australia
| | - Anders Oldner
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Physiology and Pharmacology Section of Anaesthesia and Intensive Care Karolinska Institutet Stockholm Sweden
| | - Rinaldo Bellomo
- Department of Intensive Care Austin Hospital Melbourne Australia
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Physiology and Pharmacology Section of Anaesthesia and Intensive Care Karolinska Institutet Stockholm Sweden
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Wang J, Zhu CK, Yu JQ, Tan R, Yang PL. Hypoglycemia and mortality in sepsis patients: A systematic review and meta-analysis. Heart Lung 2021; 50:933-940. [PMID: 34433111 DOI: 10.1016/j.hrtlng.2021.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/09/2021] [Accepted: 07/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hypoglycemia frequently occurs in patients with sepsis. The status of prognosis of sepsis patients varies with the cause of hypoglycemia. OBJECTIVE A meta-analysis was performed to obtain a reliable basis for assessing the severity of disease in sepsis patients. METHODS A search of electronic databases was performed. The random-effects model was employed to calculate the overall odds ratio (OR) and 95% CI. RESULTS Five cohort studies were included. Decreased blood glucose level was associated with an increased risk of death [OR:1.68; 95% CI (1.12-2.53)]. Incidents of mortality were analyzed based on the causative factor of hypoglycemia. Patients with spontaneous hypoglycemia showed a significantly higher mortality rate than the control subjects[OR 1.65; 95% CI (1.20-2.28); p = 0.002]. CONCLUSION In the early stages of sepsis, the occurrence of spontaneous hypoglycemia may be associated with the severity of the disease.
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Affiliation(s)
- Jing Wang
- Graduate school of Dalian Medical University, Dalian, Liaoning, China; Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Cheng-Kai Zhu
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Jiang-Quan Yu
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China; Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China.
| | - Rui Tan
- Graduate school of Dalian Medical University, Dalian, Liaoning, China; Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Peng-Lei Yang
- Graduate school of Dalian Medical University, Dalian, Liaoning, China; Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
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Personalized vital signs control based on continuous action-space reinforcement learning with supervised experience. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Blood glucose-related indicators are associated with in-hospital mortality in critically ill patients with acute pancreatitis. Sci Rep 2021; 11:15351. [PMID: 34321549 PMCID: PMC8319392 DOI: 10.1038/s41598-021-94697-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/15/2021] [Indexed: 11/08/2022] Open
Abstract
Acute pancreatitis (AP) results in potentially harmful blood glucose fluctuations, affecting patient prognosis. This study aimed to explore the relationship between blood glucose-related indicators and in-hospital mortality in critically ill patients with AP. We extracted data on AP patients from the Multiparameter Intelligent Monitoring in Intensive Care III database. Initial glucose (Glucose_initial), maximum glucose (Glucose_max), minimum glucose (Glucose_min), mean glucose (Glucose_mean), and glucose variability (glucose standard deviation [Glucose_SD] and glucose coefficient of variation [Glucose_CV]) were selected as blood glucose-related indicators. Logistic regression models and the Lowess smoothing curves were used to display the association between significant blood glucose-related indicators and in-hospital mortality. Survivors and non-survivors showed significant differences in Glucose_max, Glucose_mean, Glucose_SD, and Glucose_CV (P < 0.05). Glucose_max, Glucose_mean, Glucose_SD, and Glucose_CV were risk factors for in-hospital mortality in AP patients (OR > 1; P < 0.05). According to the Lowess smoothing curve, the overall trends of blood glucose-related indicators showed a non-linear correlation with in-hospital mortality. Glucose_max, Glucose_mean, Glucose_SD, and Glucose_CV were associated with in-hospital mortality in critically ill patients with AP.
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Yang F, Zeng F, Luo X, Lei Y, Li J, Lu S, Huang X, Lan Y, Liu R. GLP-1 Receptor: A New Target for Sepsis. Front Pharmacol 2021; 12:706908. [PMID: 34335269 PMCID: PMC8316682 DOI: 10.3389/fphar.2021.706908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022] Open
Abstract
Patients with sepsis often exhibit hyperglycemia, which increases mortality. glucagon-like peptide-1 receptor agonists (GLP-1RAs) not only regulate blood glucose homeostasis but also improve organ dysfunction, regulate immunity, and control inflammation and other functions in patients with sepsis. Here, we review the possible application of GLP-1RAs in sepsis, to provide a new perspective for the clinical diagnosis and treatment of patients with sepsis complicated with stress hyperglycemia.
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Affiliation(s)
| | | | | | | | | | | | | | - Yunping Lan
- Department of ICU, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Rongan Liu
- Department of ICU, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Loss of FOXO transcription factors in the liver mitigates stress-induced hyperglycemia. Mol Metab 2021; 51:101246. [PMID: 33964506 PMCID: PMC8175408 DOI: 10.1016/j.molmet.2021.101246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/21/2021] [Accepted: 04/29/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Stress-induced hyperglycemia is associated with poor outcomes in nearly all critical illnesses. This acute elevation in glucose after injury or illness is associated with increased morbidity and mortality, including multiple organ failure. Stress-induced hyperglycemia is often attributed to insulin resistance as controlling glucose levels via exogenous insulin improves outcomes, but the mechanisms are unclear. Forkhead box O (FOXO) transcription factors are direct targets of insulin signaling in the liver that regulate glucose homeostasis via direct and indirect pathways. Loss of hepatic FOXO transcription factors reduces hyperglycemia in chronic insulin resistance; however, the role of FOXOs in stress-induced hyperglycemia is unknown. Methods We subjected mice lacking FOXO transcription factors in the liver to a model of injury known to cause stress-induced hyperglycemia. Glucose, insulin, glycerol, fatty acids, cytokines, and adipokines were assessed before and after injury. Liver and adipose tissue were analyzed for changes in glycogen, FOXO target gene expression, and insulin signaling. Results Stress-induced hyperglycemia was associated with reduced hepatic insulin signaling and increased hepatic FOXO target gene expression while loss of FOXO1, 3, and 4 in the liver attenuated hyperglycemia and prevented hyperinsulinemia. Mechanistically, the loss of FOXO transcription factors mitigated the stress-induced hyperglycemia response by directly altering gene expression and glycogenolysis in the liver and indirectly suppressing lipolysis in adipose tissue. Reductions were associated with decreased IL-6, TNF-α, and follistatin and increased FGF21, suggesting that cytokines and FOXO-regulated hepatokines contribute to the stress-induced hyperglycemia response. Conclusions This study implicates FOXO transcription factors as a predominant driver of stress-induced hyperglycemia through means that include cross-talk between the liver and adipose, highlighting a novel mechanism underlying acute hyperglycemia and insulin resistance in stress. Liver forkhead box O (FOXO) target gene expression is increased in critical illness. Loss of FOXO1, 3, and 4 in the liver mitigates stress-induced hyperglycemia (SIH). Hepatic FOXO drives SIH via direct and indirect means in the liver and adipose.
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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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The Association of Diabetes and Hyperglycemia on Inpatient Readmissions. Endocr Pract 2021; 27:413-418. [PMID: 33839023 DOI: 10.1016/j.eprac.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 01/10/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the association between inpatient glycemic control and readmission in individuals with diabetes and hyperglycemia (DM/HG). METHODS Two data sets were analyzed from fiscal years 2011 to 2013: hospital data using the International Classification of Diseases, Ninth Revision (ICD-9) codes for DM/HG and point of care (POC) glucose monitoring. The variables analyzed included gender, age, mean, minimum and maximum glucose, along with 4 measures of glycemic variability (GV), standard deviation, coefficient of variation, mean amplitude of glucose excursions, and average daily risk range. RESULTS Of 66 518 discharges in FY 2011-2013, 28.4% had DM/HG based on ICD-9 codes and 53% received POC monitoring. The overall readmission rate was 13.9%, although the rates for individuals with DM/HG were higher at 18.9% and 20.6% using ICD-9 codes and POC data, respectively. The readmitted group had higher mean glucose (169 ± 47 mg/dL vs 158 ± 46 mg/dL, P < .001). Individuals with severe hypoglycemia and hyperglycemia had the highest readmission rates. All 4 GV measures were consistent and higher in the readmitted group. CONCLUSION Individuals with DM/HG have higher 30-day readmission rates than those without. Those readmitted had higher mean glucose, more extreme glucose values, and higher GV. To our knowledge, this is the first report of multiple metrics of inpatient glycemic control, including GV, and their associations with readmission.
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Zhang X, Zhang J, Li J, Gao Y, Li R, Jin X, Wang X, Huang Y, Wang G. Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure. Sci Rep 2021; 11:7747. [PMID: 33833344 PMCID: PMC8032795 DOI: 10.1038/s41598-021-87409-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/24/2021] [Indexed: 12/24/2022] Open
Abstract
Evidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.
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Affiliation(s)
- Xiaoling Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Jingjing Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Jiamei Li
- Department of Critical Care Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Ya Gao
- Department of Critical Care Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Ruohan Li
- Department of Critical Care Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Xuting Jin
- Department of Critical Care Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Xiaochuang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Ye Huang
- Department of Emergency Medicine, Xi Yuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
| | - Gang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China.
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Ravi R, Balasubramaniam V, Kuppusamy G, Ponnusankar S. Current concepts and clinical importance of glycemic variability. Diabetes Metab Syndr 2021; 15:627-636. [PMID: 33743360 DOI: 10.1016/j.dsx.2021.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Evolving evidence indicate that variations in blood glucose levels are likely to be an important factor in developing diabetic complications. Monitoring glucose fluctuations in patients remains as a therapeutic challenge and more evidence needs to be created in order to bring GV into limelight. This review encapsulates the most important findings conducted and discusses on them to provide readers a better understanding on this emerging subject. METHODS Keyword-based comprehensive desktop search was conducted to gather the relevant literature. Triple-stage cascade type content analysis of the literature was conducted to draw relevant themes of discussions. RESULTS High glycemic variability is associated with an increased risk of development of diabetic complications especially in cardiac conditions. The widely used and accepted metrics to determine the variations in blood glucose are Standard deviation (SD), MAGE (Mean amplitude of glycemic excursions) and MODD (Mean of daily differences). Occurrence of blood glucose variations affects at a molecular level thereby causing more harm than the occurrence of hyperglycemia alone. CONCLUSION Available data suggest that Glycemic Variability should be used as an additional marker of glycemia. Additional research globally, and in India are required.
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Affiliation(s)
- Ramya Ravi
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Udhagamandalam, The Nilgiris, Tamil Nadu, India
| | - V Balasubramaniam
- Department of Surgery, Govt. Medical College Hospital, Udhagamandalam, The Nilgiris, Tamil Nadu, India
| | - Gowthamarajan Kuppusamy
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Udhagamandalam, The Nilgiris, Tamil Nadu, India
| | - Sivasankaran Ponnusankar
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Udhagamandalam, The Nilgiris, Tamil Nadu, India.
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Lionte C, Bologa C, Agafiti I, Sorodoc V, Petris OR, Jaba E, Sorodoc L. Association of Multiple Glycemic Parameters at Hospital Admission with Mortality and Short-Term Outcomes in Acutely Poisoned Patients. Diagnostics (Basel) 2021; 11:diagnostics11020361. [PMID: 33672765 PMCID: PMC7924603 DOI: 10.3390/diagnostics11020361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/06/2021] [Accepted: 02/18/2021] [Indexed: 12/15/2022] Open
Abstract
The prognostic value of multiple glycemic parameters in poisoned patients was never assessed. We aim to explore the effects of glucose variability on short-term outcomes in nondiabetic and diabetic patients acutely poisoned with undifferentiated xenobiotics. We performed a prospective observational study in a tertiary center for toxicology in northeastern Romania. Over the course of 3 years, we included 1076 adults, older than 18 years, admitted for acute poisoning with a xenobiotic. The mortality rate was 4.1%. The admission blood glucose level (BGL) predicted mortality (OR 1.015, 95% CI 1.011–1.019, p < 0.001) and complications (OR 1.005, 95% CI 1.001–1.009, p 0.02). The mean glucose level (MGL) after admission (OR 1.007, 95% CI 1.000–1.013, p 0.034) and coefficient of glucose variability (CV) were predictive for complications (OR 40.58, 95% CI 1.35–1220.52, p 0.033), using the same multivariable model. The receiver operating characteristic curve (ROC) analysis revealed that BGL had good predictive value for in-hospital mortality (area under the curve (AUC) = 0.744, 95% CI = 0.648–0.841, p < 0.001), and complications (AUC = 0.618, 95% CI = 0.584–0.653, p < 0.001). In patients acutely poisoned with xenobiotics, the BGL, MGL and CV can be useful as mortality and short-outcome predictors.
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Affiliation(s)
- Catalina Lionte
- Internal Medicine and Clinical Toxicology Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.B.); (L.S.)
- 2nd Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinic County Hospital, 700111 Iasi, Romania; (I.A.); (O.R.P.)
- Correspondence: (C.L.); (V.S.); Tel.: +40-742-082-318 (C.L.); +40-232-267-801 (V.S.)
| | - Cristina Bologa
- Internal Medicine and Clinical Toxicology Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.B.); (L.S.)
- 2nd Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinic County Hospital, 700111 Iasi, Romania; (I.A.); (O.R.P.)
| | - Inga Agafiti
- 2nd Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinic County Hospital, 700111 Iasi, Romania; (I.A.); (O.R.P.)
| | - Victorita Sorodoc
- Internal Medicine and Clinical Toxicology Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.B.); (L.S.)
- 2nd Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinic County Hospital, 700111 Iasi, Romania; (I.A.); (O.R.P.)
- Correspondence: (C.L.); (V.S.); Tel.: +40-742-082-318 (C.L.); +40-232-267-801 (V.S.)
| | - Ovidiu Rusalim Petris
- 2nd Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinic County Hospital, 700111 Iasi, Romania; (I.A.); (O.R.P.)
- Internal Medicine and Nursing Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elisabeta Jaba
- Statistics Department, FEEA, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania;
| | - Laurentiu Sorodoc
- Internal Medicine and Clinical Toxicology Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.B.); (L.S.)
- 2nd Internal Medicine Clinic, “Sf. Spiridon” Emergency Clinic County Hospital, 700111 Iasi, Romania; (I.A.); (O.R.P.)
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Modrzynska J, Klein CF, Iversen K, Bundgaard H, Hartmann B, Mose M, Rittig N, Møller N, Holst JJ, Wewer Albrechtsen NJ. Plasma levels of glucagon but not GLP-1 are elevated in response to inflammation in humans. Endocr Connect 2021; 10:205-213. [PMID: 33480865 PMCID: PMC7983524 DOI: 10.1530/ec-20-0590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Glucagon and glucagon-like peptide-1 (GLP-1) originate from the common precursor, proglucagon, and their plasma concentrations have been reported to be increased during inflammatory conditions. Increased blood glucose levels are frequently observed in septic patients, and therefore we hypothesized that glucagon, but not GLP-1, is increased in individuals with inflammation. DESIGN Prospective longitudinal cohort study. MATERIALS AND METHODS We measured glucagon and GLP-1 in plasma sampled consecutively in three cohorts consisting of patients with infective endocarditis (n = 16), urosepsis (n = 28) and post-operative inflammation following percutaneous aortic valve implantation or thoracic endovascular aortic repair (n = 5). Correlations between C-reactive protein (CRP), a marker of systemic inflammation, and glucagon and GLP-1 concentrations were investigated. Additionally, glucagon and GLP-1 concentrations were measured after a bolus infusion of lipopolysaccharide (LPS, 1 ng/kg) in nine healthy young males. RESULTS Glucagon and CRP were positively and significantly correlated (r = 0.27; P = 0.0003), whereas no significant association between GLP-1 and CRP was found (r = 0.08, P = 0.30). LPS infusion resulted in acute systemic inflammation reflected by increased temperature, pulse, tumor necrosis factor-α (TNFα), interleukin-6 (IL-6) and concomitantly increased concentrations of glucagon (P < 0.05) but not GLP-1. CONCLUSIONS Systemic inflammation caused by bacterial infections or developed as a non-infected condition is associated with increased plasma concentration of glucagon, but not GLP-1. Hyperglucagonemia may contribute to the impaired glucose control in patients with systemic inflammatory diseases.
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Affiliation(s)
- Justyna Modrzynska
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Kasper Iversen
- Department of Clinical Medicine, Herlev Gentofte Hospital, Herlev, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maike Mose
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Nikolaj Rittig
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Møller
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Correspondence should be addressed to N J Wewer Albrechtsen:
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Uyttendaele V, Chase JG, Knopp JL, Gottlieb R, Shaw GM, Desaive T. Insulin sensitivity in critically ill patients: are women more insulin resistant? Ann Intensive Care 2021; 11:12. [PMID: 33475909 PMCID: PMC7818291 DOI: 10.1186/s13613-021-00807-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background Glycaemic control (GC) in intensive care unit is challenging due to significant inter- and intra-patient variability, leading to increased risk of hypoglycaemia. Recent work showed higher insulin resistance in female preterm neonates. This study aims to determine if there are differences in inter- and intra-patient metabolic variability between sexes in adults, to gain in insight into any differences in metabolic response to injury. Any significant difference would suggest GC and randomised trial design should consider sex differences to personalise care. Methods Insulin sensitivity (SI) levels and variability are identified from retrospective clinical data for men and women. Data are divided using 6-h blocks to capture metabolic evolution over time. In total, 91 male and 54 female patient GC episodes of minimum 24 h are analysed. Hypothesis testing is used to determine whether differences are significant (P < 0.05), and equivalence testing is used to assess whether these differences can be considered equivalent at a clinical level. Data are assessed for the raw cohort and in 100 Monte Carlo simulations analyses where the number of men and women are equal. Results Demographic data between females and males were all similar, including GC outcomes (safety from hypoglycaemia and high (> 50%) time in target band). Females had consistently significantly lower SI levels than males, and this difference was not clinically equivalent. However, metabolic variability between sexes was never significantly different and always clinically equivalent. Thus, inter-patient variability was significantly different between males and females, but intra-patient variability was equivalent. Conclusion Given equivalent intra-patient variability and significantly greater insulin resistance, females can receive the same benefit from safe, effective GC as males, but may require higher insulin doses to achieve the same glycaemia. Clinical trials should consider sex differences in protocol design and outcome analyses.
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Affiliation(s)
- Vincent Uyttendaele
- GIGA-In silico Medicine,, University of Liège, Allée du 6 Août 19, Bât. B5a, 4000, Liège, Belgium. .,Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
| | - J Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand
| | - Jennifer L Knopp
- GIGA-In silico Medicine,, University of Liège, Allée du 6 Août 19, Bât. B5a, 4000, Liège, Belgium
| | - Rebecca Gottlieb
- Medtronic Diabetes, 18000 Devonshire St, Northridge, CA, 91325, USA
| | - Geoffrey M Shaw
- Christchurch Hospital, Dept of Intensive Care, Christchurch, New Zealand and University of Otago, School of Medicine, Christchurch, New Zealand
| | - Thomas Desaive
- GIGA-In silico Medicine,, University of Liège, Allée du 6 Août 19, Bât. B5a, 4000, Liège, Belgium
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48
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Uyttendaele V, Chase JG, Knopp JL, Gottlieb R, Shaw GM, Desaive T. Insulin sensitivity in critically ill patients: are women more insulin resistant? Ann Intensive Care 2021. [PMID: 33475909 DOI: 10.1186/s13613-021-00807-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Glycaemic control (GC) in intensive care unit is challenging due to significant inter- and intra-patient variability, leading to increased risk of hypoglycaemia. Recent work showed higher insulin resistance in female preterm neonates. This study aims to determine if there are differences in inter- and intra-patient metabolic variability between sexes in adults, to gain in insight into any differences in metabolic response to injury. Any significant difference would suggest GC and randomised trial design should consider sex differences to personalise care. METHODS Insulin sensitivity (SI) levels and variability are identified from retrospective clinical data for men and women. Data are divided using 6-h blocks to capture metabolic evolution over time. In total, 91 male and 54 female patient GC episodes of minimum 24 h are analysed. Hypothesis testing is used to determine whether differences are significant (P < 0.05), and equivalence testing is used to assess whether these differences can be considered equivalent at a clinical level. Data are assessed for the raw cohort and in 100 Monte Carlo simulations analyses where the number of men and women are equal. RESULTS Demographic data between females and males were all similar, including GC outcomes (safety from hypoglycaemia and high (> 50%) time in target band). Females had consistently significantly lower SI levels than males, and this difference was not clinically equivalent. However, metabolic variability between sexes was never significantly different and always clinically equivalent. Thus, inter-patient variability was significantly different between males and females, but intra-patient variability was equivalent. CONCLUSION Given equivalent intra-patient variability and significantly greater insulin resistance, females can receive the same benefit from safe, effective GC as males, but may require higher insulin doses to achieve the same glycaemia. Clinical trials should consider sex differences in protocol design and outcome analyses.
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Affiliation(s)
- Vincent Uyttendaele
- GIGA-In silico Medicine,, University of Liège, Allée du 6 Août 19, Bât. B5a, 4000, Liège, Belgium. .,Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
| | - J Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand
| | - Jennifer L Knopp
- GIGA-In silico Medicine,, University of Liège, Allée du 6 Août 19, Bât. B5a, 4000, Liège, Belgium
| | - Rebecca Gottlieb
- Medtronic Diabetes, 18000 Devonshire St, Northridge, CA, 91325, USA
| | - Geoffrey M Shaw
- Christchurch Hospital, Dept of Intensive Care, Christchurch, New Zealand and University of Otago, School of Medicine, Christchurch, New Zealand
| | - Thomas Desaive
- GIGA-In silico Medicine,, University of Liège, Allée du 6 Août 19, Bât. B5a, 4000, Liège, Belgium
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El Toony L, El Zohri M, Abo Elghait A. Admission hyperglycemia and its implications on outcome in patients attending medical intensive care units at Assiut University Hospital. JOURNAL OF DIABETOLOGY 2021. [DOI: 10.4103/jod.jod_28_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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50
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Knopp JL, Bishop K, Lerios T, Chase JG. Capacity of Infusion Lines for Insulin Adsorption: Effect of Flow Rate on Total Adsorption. J Diabetes Sci Technol 2021; 15:109-120. [PMID: 31561709 PMCID: PMC7783010 DOI: 10.1177/1932296819876924] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Insulin adsorption to clinical materials has been well observed, but not well quantified. Insulin adsorption reduces expected and actual insulin delivery and is unaccounted for in insulin therapy or glycemic control. It may thus contribute to poor control and high glycemic variability. This research quantifies the problem in the context of clinical use. METHOD Experimental insulin adsorption data from literature is used to calculate insulin delivery and total insulin adsorption capacities for polyethylene (PE) and polyvinal chloride (PVC) lines at clinically relevant flow rates and concentrations. RESULTS Insulin adsorption capacity decreased hyperbolically with flow rate for both PE and PVC, where low flow scenarios result in greater insulin adherence to infusion lines. When the infusion flow rate was halved from 1 to 0.5 mL/h, twice as much insulin adsorbed to the line. Insulin loss to adsorption resulted in up to ~50% of intended insulin not delivered over 24 hours in a low flow and low concentration context. CONCLUSION Material capacity for insulin adsorption is not constant, but increases with decreasing flow. Different materials have different adsorption capacities. In low flow and low concentration contexts, such as in neonatal or pediatric intensive care, insulin loss to adsorption represents a significant proportion of daily insulin delivery, which needs to be accounted for.
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Affiliation(s)
- Jennifer L. Knopp
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
- Jennifer L. Knopp, PhD, Department of Mechanical Engineering, University of Canterbury, 20 Kirkwood Ave, Riccarton, Christchurch 8041, New Zealand.
| | - Kaia Bishop
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Theodore Lerios
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - J. Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
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