1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Wang Y, Qing S, Yang J, Qian D. SCH772984 ameliorates lipopolysaccharide-induced hypoglycemia in mice through reversing MEK/ERK/Foxo1-mediated gluconeogenesis suppression. Can J Physiol Pharmacol 2024; 102:33-41. [PMID: 37944129 DOI: 10.1139/cjpp-2023-0133] [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] [Indexed: 11/12/2023]
Abstract
Lipopolysaccharide (LPS) results in a lethal hypoglycemic response. However, the main molecular mechanism involved in LPS-induced glucose metabolism disorder is poorly understood. This study intends to investigate the signaling pathways involved in LPS-induced hypoglycemia and potential efficacy of extracellular signal-regulated kinase (ERK) inhibitor SCH772984. The effects of LPS and SCH772984 on gluconeogenesis, glucose absorption, and glycogenolysis were evaluated by pyruvate tolerance test, oral glucose tolerance test, and glucagon test, respectively. After a single intraperitoneal injection of 0.5 mg/kg LPS, the mice's blood glucose levels and gluconeogenesis ability were significantly lower than that of control group. Besides, mRNA and protein expression of glucose-6-phosphatase (G6Pase) and phosphoenolpyruvate carboxykinase (PEPCK) decreased significantly after LPS treatment. LPS induced the phosphorylation of ERK1/2, MEK1/2 (mitogen-activated protein kinase), and Foxo1 while inhibited Foxo1 expression in the nucleus, indicating an important role of the MEK/ERK/Foxo1 signaling in the inhibition of gluconeogenesis by LPS. Furthermore, SCH772984 elevated blood glucose, increased the G6Pase and PEPCK expression, and inhibited pERK1/2 and pFoxo1 expression in LPS-induced mice. In summary, LPS inhibited gluconeogenesis and induced hypoglycemia through the MEK/ERK/Foxo1 signal pathway, and ERK inhibitor could effectively reverse decreased blood glucose in mice with LPS treatment. These findings provide a novel therapeutic target for LPS-induced hypoglycemia.
Collapse
Affiliation(s)
- Yirong Wang
- Department of Pharmacy, The Third People's Hospital of Chengdu, The Second Affiliated Clinical College of Chongqing Medical University, Chengdu 610014, People's Republic of China
| | - Shuyun Qing
- Department of Pharmacy, The Third People's Hospital of Chengdu, The Second Affiliated Clinical College of Chongqing Medical University, Chengdu 610014, People's Republic of China
| | - Jing Yang
- Department of Pharmacy, The Third People's Hospital of Chengdu, The Second Affiliated Clinical College of Chongqing Medical University, Chengdu 610014, People's Republic of China
| | - Dehui Qian
- Department of Cardiology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
The association of ESBL Escherichia coli with mortality in patients with Escherichia coli bacteremia at the emergency department. Drug Target Insights 2022; 16:12-16. [PMID: 36304435 PMCID: PMC9589459 DOI: 10.33393/dti.2022.2422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Escherichia coli is a common bloodstream infection pathogen in the emergency department (ED). Patients with extended-spectrum beta-lactamase (ESBL) E. coli have a higher risk of morbidity. However, there is still debate surrounding ESBL E. coli-associated mortality in community, intensive care unit, and tertiary care settings. In addition, there have been few studies regarding mortality in ESBL E. coli in ED settings, and results have been contradictory.
Methods: This was a retrospective cohort study conducted at the Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University in Thailand aimed at evaluating the possible association between ESBL E. coli bacteremia and mortality in the ED. The inclusion criteria were age 18 years or over, clinical presentation suspicious of infection, and positive blood culture for E. coli. Predictors for mortality were analyzed by logistic regression analysis.
Results: During the study period, 273 patients presented at the ED with hemoculture positive for E. coli. Of those, 27 (9.89%) died. Five factors remained in the final model, of which plasma glucose levels, serum lactate levels, and ESBL E. coliwere significantly associated with 28-day mortality in the ED with adjusted odds ratios of 0.970, 1.258, and 12.885, respectively. Plasma glucose of less than 113 mg/dL yielded a sensitivity of 80.95% and specificity of 64.29%, while serum lactate over 2.4 mmol/L had a sensitivity of 81.48% and specificity of 45.50%.
Conclusion: ESBL E. coli, plasma glucose, and serum lactate levels were associated with 28-day mortality in patients with E. coli bacteremia presenting at the ED.
Collapse
|
5
|
Obeidat AE, Mahfouz R, Benavente K, Kozai LA, Mansour MM, Darweesh M, Pyrsopoulos NT. Hypoglycemia Is Associated With Worse Outcomes in Patients With Cholangitis Despite Undergoing Endoscopic Retrograde Cholangiopancreatography. Cureus 2022; 14:e26964. [PMID: 35989813 PMCID: PMC9382686 DOI: 10.7759/cureus.26964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 12/07/2022] Open
|
6
|
Adapted Murine Sepsis Score: Improving the Research in Experimental Sepsis Mouse Model. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5700853. [PMID: 35127944 PMCID: PMC8814713 DOI: 10.1155/2022/5700853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022]
Abstract
The Murine Sepsis Score (MSS) is used to assess the severity of sepsis in rats and mice based on observational characteristics. The quantitative variables of glycemia, body weight, and temperature are predictors of severity in experimental models of sepsis. Therefore, our study sought to adapt the MSS with the same variables to indicate earlier the severity of the disease in murine models of the disease. Sepsis mice presented hypoglycemia, weight loss, and hypothermia. Therefore, these variables were included in the Adapted Murine Sepsis Score (A-MSS). The A-MASS presented 100% specificity and 87.5% sensibility been able to differentiate the early sepsis symptoms and its severity. The A-MSS allows an early and more complete diagnosis of sepsis in mice and might be considered as a procedure to improve the analysis of systemic sepsis dysfunction in murine experimental models.
Collapse
|
7
|
Kant R, Yadav P, Pratti M, Barnwal S. Hypoglycemia: Elucidating its circadian propensity and recovery time based on clinical parameters. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:29-37. [PMID: 35178205 PMCID: PMC8797821 DOI: 10.22088/cjim.13.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Hypoglycemia is frequently associated with insulin therapy in diabetic patients; it leads to many short and long-term complications and even death if not addressed in time. This study was undertaken to observe the circadian propensity of hypoglycemia and its recovery time based on type 2 diabetes mellitus patients' clinical parameters. METHODS We included type 2 diabetes mellitus (DM) hospitalized patients with the exclusion of patients suffering from critical illness. Data were collected for a period of three months (September to November 2019). RESULTS A total of 120 patients were included, comprising 60% males and 40% females. Approximately 55% of patients had hypoglycemic episodes at around 12 am- 6 am. The most common comorbidity present in these patients was hypertension (43.3%, P=0.931). Anemia (OR-3.765, CI-1.350-5.500, P=0.011), retinopathy (OR 6.066, CI-2.031-8.113, P=0.001), and duration of DM (OR-6.266, CI-2.209-7.774, P=0.001) were significantly associated with the recovery time of hypoglycemia, around 50±14.14min in the elderly population of age 60-70. People with BMI 22.5- 27.5 Kg/m2 took around 45.66 ± 19.37 min to recover after treatment. CONCLUSION Time taken to recover from hypoglycemic episodes vary with age and BMI. Associated comorbidities such as anemia, retinopathy, and DM duration had a significant bearing on the time taken to recover from hypoglycemia. Recovery time was directly proportional to BMI, a new finding that needs further molecular level evaluation. Circadian propensity of hypoglycemia in these patients have been identified in the early morning hours of the day.
Collapse
Affiliation(s)
- Ravi Kant
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Poonam Yadav
- Center of Excellence in Nursing Education and Research, All India Institute of Medical Sciences, Rishikesh, India
| | - Madhuri Pratti
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Shruti Barnwal
- Department of Dermatology, Govt. Doon Medical College, Dehradun, India
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
de Souza Galia WB, Biazi GR, Frasson-Uemura IG, Miksza DR, Zaia CTBV, Zaia DAM, de Souza HM, Bertolini GL. Gluconeogenesis is reduced from alanine, lactate and pyruvate, but maintained from glycerol, in liver perfusion of rats with early and late sepsis. Cell Biochem Funct 2021; 39:754-762. [PMID: 33913177 DOI: 10.1002/cbf.3637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/12/2021] [Indexed: 11/09/2022]
Abstract
Sepsis induces several metabolic abnormalities, including hypoglycaemia in the most advanced stage of the disease, a risk factor for complications and death. Although hypoglycaemia can be caused by inhibition of hepatic gluconeogenesis, decreased and increased gluconeogenesis were reported in sepsis. Furthermore, gluconeogenesis from glycerol was not yet evaluated in this disease. The main purpose of this study was to investigate the gluconeogenesis from alanine, lactate, pyruvate and glycerol in rats with early (8 hours) and late (18 hours) sepsis. Parameters related to the characterization of sepsis were also evaluated. Sepsis was induced by cecal ligation and puncture and gluconeogenesis was assessed in liver perfusion. Rats with early and late sepsis showed increased lactataemia, depletion of liver glycogen and peripheral insulin resistance, characterizing the establishment of sepsis. Rats with early and late sepsis showed decreased gluconeogenesis from alanine, lactate and pyruvate. Interestingly, gluconeogenesis from glycerol, a precursor that enters in the pathway at a later step, subsequent to the entry of alanine, lactate and pyruvate, was maintained in rats with early and late sepsis. In conclusion, gluconeogenesis is decreased from alanine, lactate and pyruvate, but maintained from glycerol, in liver perfusion of rats with early and late sepsis. SIGNIFICANCE OF THE STUDY: The maintenance of gluconeogenesis from glycerol, but not from alanine, lactate and pyruvate, together with the liver glycogen depletion, points the glycerol as an important precursor for the maintenance of glycaemic homeostasis in sepsis. The findings open the possibility of further investigation on the administration of glycerol in the treatment of hypoglycaemia associated with more advanced sepsis.
Collapse
Affiliation(s)
| | - Giuliana Regina Biazi
- Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
| | | | - Daniele Romani Miksza
- Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
| | | | | | | | | |
Collapse
|
11
|
Furr M, McKenzie H. Factors associated with the risk of positive blood culture in neonatal foals presented to a referral center (2000-2014). J Vet Intern Med 2020; 34:2738-2750. [PMID: 33044020 PMCID: PMC7694804 DOI: 10.1111/jvim.15923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 01/12/2023] Open
Abstract
Background Bloodstream infections (BSI) are common in sick foals and increase foal morbidity and mortality when they occur. Recognition of risk factors for BSI could be an important means to limit their occurrence, but studies on this topic are limited. Objectives Historical as well as maternal and foal physical examination findings will predict risk of BSI in neonatal foals. Animals Foals <14 days of age admitted to a referral equine hospital for care. Methods Retrospective case‐control study with univariate and multivariable logistic regression analysis. Results Four hundred twenty‐nine (143 cases and 286 controls) foals <14 days of age were studied. Risk of a foal having a BSI was increased in foals with umbilical disease (adjusted odds ratio [OR], 11.01; P = .02), hypoglycemia (adjusted OR, 13.51; P = .03), and the combined presence of umbilical disease and low hematocrit (adjusted OR, >999.99; P = .04). Factors not found to be risk factors for development of BSI included prematurity, hypothermia, abdominal disease, diarrhea, failure of passive transfer, and maternal uterine infection. Conclusions and Clinical Importance Several historical and physical examination findings increase the risk of foals being blood culture positive at presentation to the hospital. This knowledge may aid early identification of blood culture status, thus aiding in treatment decisions.
Collapse
Affiliation(s)
- Martin Furr
- College of Veterinary Medicine, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Harold McKenzie
- Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| |
Collapse
|
12
|
Shah FA, Mahmud H, Gallego-Martin T, Jurczak MJ, O’Donnell CP, McVerry BJ. Therapeutic Effects of Endogenous Incretin Hormones and Exogenous Incretin-Based Medications in Sepsis. J Clin Endocrinol Metab 2019; 104:5274-5284. [PMID: 31216011 PMCID: PMC6763279 DOI: 10.1210/jc.2019-00296] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sepsis, a complex disorder characterized by a dysregulated immune response to an inciting infection, affects over one million Americans annually. Dysglycemia during sepsis hospitalization confers increased risk of organ dysfunction and death, and novel targets for the treatment of sepsis and maintenance of glucose homeostasis are needed. Incretin hormones are secreted by enteroendocrine cells in response to enteral nutrients and potentiate insulin release from pancreatic β cells in a glucose-dependent manner, thereby reducing the risk of insulin-induced hypoglycemia. Incretin hormones also reduce systemic inflammation in preclinical studies, but studies of incretins in the setting of sepsis are limited. METHODS In this bench-to-bedside mini-review, we detail the evidence to support incretin hormones as a therapeutic target in patients with sepsis. We performed a PubMed search using the medical subject headings "incretins," "glucagon-like peptide-1," "gastric inhibitory peptide," "inflammation," and "sepsis." RESULTS Incretin-based therapies decrease immune cell activation, inhibit proinflammatory cytokine release, and reduce organ dysfunction and mortality in preclinical models of sepsis. Several small clinical trials in critically ill patients have suggested potential benefit in glycemic control using exogenous incretin infusions, but these studies had limited power and were performed in mixed populations. Further clinical studies examining incretins specifically in septic populations are needed. CONCLUSIONS Targeting the incretin hormone axis in sepsis may provide a means of not only promoting euglycemia in sepsis but also attenuating the proinflammatory response and improving clinical outcomes.
Collapse
Affiliation(s)
- Faraaz Ali Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Correspondence and Reprint Requests: Faraaz Ali Shah, MD, MPH, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, 3459 Fifth Avenue NW, 628 MUH, Pittsburgh, Pennsylvania 15213. E-mail:
| | - Hussain Mahmud
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Teresa Gallego-Martin
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael J Jurczak
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher P O’Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryan J McVerry
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
13
|
Vandermosten L, Vanhorebeek I, De Bosscher K, Opdenakker G, Van den Steen PE. Critical Roles of Endogenous Glucocorticoids for Disease Tolerance in Malaria. Trends Parasitol 2019; 35:918-930. [PMID: 31606404 DOI: 10.1016/j.pt.2019.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
Abstract
During malaria, the hypothalamic-pituitary-adrenal (HPA) axis is activated and glucocorticoid (GC) levels are increased, but their essential roles have been largely overlooked. GCs are decisive for systemic regulation of vital processes such as immune responses, vascular function, and metabolism, which are crucial in malaria. Here, we introduce GCs in general, followed by their versatile roles for disease tolerance in malaria. A complementary comparison is provided with their role in sepsis. Finally, potential translational implications are considered. The failed clinical trials of dexamethasone against cerebral malaria in the past have diminished the interest in GCs in malaria. However, the issue of relative corticosteroid insufficiency has barely been explored in malaria patients, but may hold promise for a better understanding and treatment of specific malaria complications.
Collapse
Affiliation(s)
- Leen Vandermosten
- Laboratory of Immunoparasitology, Department of Microbiology, Immunology, and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Ilse Vanhorebeek
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Karolien De Bosscher
- Translational Nuclear Receptor Research Laboratory, VIB Center for Medical Biotechnology, Department of Biomolecular Medicine, UGent, Ghent, Belgium
| | - Ghislain Opdenakker
- Laboratory of Immunobiology, Department of Microbiology, Immunology, and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Philippe E Van den Steen
- Laboratory of Immunoparasitology, Department of Microbiology, Immunology, and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
| |
Collapse
|
14
|
Shah FA, Kitsios GD, Zhang Y, Morris A, Yende S, Huang DT, O'Donnell CP, McVerry BJ. Rationale for and Design of the Study of Early Enteral Dextrose in Sepsis: A Pilot Placebo-Controlled Randomized Clinical Trial. JPEN J Parenter Enteral Nutr 2019; 44:541-547. [PMID: 31148210 DOI: 10.1002/jpen.1608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/19/2019] [Accepted: 05/03/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sepsis is characterized by life-threatening organ dysfunction caused by a dysregulated host response to infection and affects over 1 million Americans annually. Loss of glycemic control in sepsis is associated with increased morbidity and mortality, and novel approaches are needed to promote euglycemia and improve outcomes in sepsis. Recent studies from our laboratory demonstrate that early low-level enteral dextrose infusion in septic mice attenuates the systemic inflammatory response and improves glycemic control by inducing intestine-derived incretin hormone secretion. AIM The aim of the Study of Early Enteral Dextrose in Sepsis (SEEDS) is to test the effect of a 24-hour enteral dextrose infusion in critically ill septic patients as a therapeutic agent to decrease systemic inflammation and promote euglycemia. METHODS SEEDS is a single-center, double-blind, randomized, controlled trial that will enroll 60 septic patients admitted to the intensive care units at the University of Pittsburgh Medical Center Health System in Pittsburgh. Participants will be randomized 1:1 to receive enteral dextrose (n = 30) or water (placebo, n = 30) infusion for 24 hours. The primary outcome is the circulating interleukin-6 level measured after the 24-hour infusion compared between dextrose and placebo groups. Secondary outcomes include postinfusion circulating insulin, incretin, and other proinflammatory cytokine levels, as well as incidence of hyperglycemia and hypoglycemia during the infusion period. DISCUSSION This trial will characterize the effects of early enteral dextrose on endogenous endocrine pathways and the systemic inflammatory response in sepsis. The results of this trial will inform future larger interventional studies of early enteral nutrients in critically ill patients with sepsis.
Collapse
Affiliation(s)
- Faraaz Ali Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Veteran Affairs, Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Georgios D Kitsios
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yingze Zhang
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alison Morris
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sachin Yende
- Veteran Affairs, Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David T Huang
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher P O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bryan J McVerry
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
15
|
Wernly B, Jirak P, Lichtenauer M, Franz M, Kabisch B, Schulze PC, Braun K, Muessig J, Masyuk M, Paulweber B, Lauten A, Hoppe UC, Kelm M, Jung C. Hypoglycemia but Not Hyperglycemia Is Associated with Mortality in Critically Ill Patients with Diabetes. Med Princ Pract 2019; 28:186-192. [PMID: 30544102 PMCID: PMC6545909 DOI: 10.1159/000496205] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/13/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Both severe hyperglycemia (> 200 mg/dL) and hypoglycemia (≤70 mg/dL) are known to be associated with increased mortality in critically ill patients. Therefore, we investigated associations of a single episode of blood glucose deviation (concentration either ≤70 mg/dL and/or > 200 mg/dL) during an intensive care unit (ICU) stay with mortality in these patients. METHODS A total of 4,986 patients (age 65 ± 15 years; 39% female; 14% type 2 diabetes [T2DM] based on medical records) admitted to a German ICU in a tertiary care hospital were investigated retrospectively. The intra-ICU and long-term mortality of patients between 4 and 7 years after their ICU submission were assessed. RESULTS A total 62,659 glucose measurements were analyzed. A single glucose deviation was associated with adverse outcomes compared to patients without a glucose deviation, represented by both intra-ICU mortality (22 vs. 10%; OR 2.62; 95% CI 2.23-3.09; p < 0.001) and long-term mortality (HR 2.01; 95% CI 1.81-2.24; p < 0.001). In patients suffering from T2DM hypoglycemia (30 vs. 13%; OR 2.94; 95% CI 2.28-3.80; p < 0.001) but not hyperglycemia (16 vs. 14%; OR 1.05; 95% CI 0.68-1.62; p = 0.84) was associated with mortality. CONCLUSION In patients with dia-betes, hypo- but not hyperglycemia was associated with increased mortality, whereas in patients without diabetes, both hyper- and hypoglycemia were associated with adverse outcome. Blood glucose concentration might need differential approaches depending on concomitant diseases.
Collapse
Affiliation(s)
- Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria,
| | - Peter Jirak
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Marcus Franz
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Bjoern Kabisch
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Paul C Schulze
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Kristina Braun
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Johanna Muessig
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Bernhard Paulweber
- Clinic of Internal Medicine I, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Alexander Lauten
- Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin, Berlin, Germany
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
16
|
Fitzpatrick SF, Gojkovic M, Macias D, Tegnebratt T, Lu L, Samén E, Rundqvist H, Johnson RS. Glycolytic Response to Inflammation Over Time: Role of Myeloid HIF-1alpha. Front Physiol 2018; 9:1624. [PMID: 30524296 PMCID: PMC6262152 DOI: 10.3389/fphys.2018.01624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/26/2018] [Indexed: 01/11/2023] Open
Abstract
The in vivo response to lipopolysaccharide (LPS) occurs rapidly and has profound physiological and metabolic effects. The hypoxia inducible (HIF) transcription factor is an intrinsic and essential part of inflammation, and is induced by LPS. To determine the importance of the HIF response in regulating metabolism following an LPS response, glucose uptake was quantified in a time dependent manner in mice lacking HIF-1α in myeloid cells. We found that deletion of HIF-1α has an acute protective effect on LPS-induced hypoglycemia. Furthermore, reduced glucose uptake was observed in the heart and brown fat, in a time dependent manner, following loss of HIF-1α. To determine the physiological significance of these findings, cardiovascular, body temperature, and blood pressure changes were subsequently quantified in real time using radiotelemetry measurements. These studies reveal the temporal aspects of HIF-1α as a regulator of the metabolic response to acute LPS-induced inflammation.
Collapse
Affiliation(s)
- Susan F Fitzpatrick
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Milos Gojkovic
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - David Macias
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Tetyana Tegnebratt
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska Experimental Research and Imaging Center, Karolinska University Hospital, Stockholm, Sweden
| | - Li Lu
- Department of Neuroradiology, Karolinska Experimental Research and Imaging Center, Karolinska University Hospital, Stockholm, Sweden.,Department of Comparative Medicine, Karolinska Experimental Research and Imaging Center, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Samén
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska Experimental Research and Imaging Center, Karolinska University Hospital, Stockholm, Sweden
| | - Helene Rundqvist
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Randall S Johnson
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom.,Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
17
|
Leung CH, Liu CP. Diabetic status and the relationship of blood glucose to mortality in adults with carbapenem-resistant Acinetobacter baumannii complex bacteremia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:654-662. [PMID: 31446929 DOI: 10.1016/j.jmii.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND/PURPOSE Diabetes is associated with increased mortality in Acinetobacter baumannii (AB) complex infection. This study investigated the risk factors and relationship of diabetic status and glycemic indices to mortality in patients with carbapenem-resistant (CR) AB complex bacteremia. METHODS Relationship of glycemic indices to mortality were compared in adult diabetes (DM) and nondiabetes (non-DM) patients with CRAB complex bacteremia hospitalized from January 2010 to December 2015 in MacKay Memorial Hospital, Taiwan. RESULTS Of 317 patients with CRAB complex bacteremia, 146 (46.06%) had diabetes. DM patients were elderly (mean age of 69.23 years) and the mortality rate was higher (64.38% vs. 52.05%, p = 0.036) than in non-DM patients. By multivariate analysis, septic shock was associated with increased mortality in DM patients. Hypoglycemia was associated with increased mortality in non-DM patients only (100% vs. 50.33%, p = 0.006). The lowest mortality was for the blood glucose range 70-100 mg/dL in non-DM patients (43.24%) and 100-140 mg/dL for DM patients (56.52%). Increased glycemic variability (coefficient of variation (CV) > 40% compared to < 20%) was associated with increased mortality in non-DM patients (86.36% vs. 47.12%, p = 0.003). CONCLUSION Effects of dysglycemia on mortality due to CRAB complex bacteremia differ according to diabetic status. Mortality was higher in DM patients. In non-DM patients, hypoglycemia and increased CV were associated with increased mortality. The lowest mortality was for the blood glucose range 70-100 mg/dL in non-DM patients and 100-140 mg/dL for DM patients.
Collapse
Affiliation(s)
- Ching-Hsiang Leung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay College of Medicine Nursing and Management, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Infection Control Committee, MacKay Memorial Hospital, Taipei, Taiwan.
| |
Collapse
|
18
|
Shah FA, Singamsetty S, Guo L, Chuan BW, McDonald S, Cooper BA, O'Donnell BJ, Stefanovski D, Wice B, Zhang Y, O'Donnell CP, McVerry BJ. Stimulation of the endogenous incretin glucose-dependent insulinotropic peptide by enteral dextrose improves glucose homeostasis and inflammation in murine endotoxemia. Transl Res 2018; 193:1-12. [PMID: 29222967 PMCID: PMC5826869 DOI: 10.1016/j.trsl.2017.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/20/2017] [Accepted: 11/08/2017] [Indexed: 12/11/2022]
Abstract
Loss of glucose homeostasis during sepsis is associated with increased organ dysfunction and higher mortality. Novel therapeutic strategies to promote euglycemia in sepsis are needed. We have previously shown that early low-level intravenous (IV) dextrose suppresses pancreatic insulin secretion and induces insulin resistance in septic mice, resulting in profound hyperglycemia and worsened systemic inflammation. In this study, we hypothesized that administration of low-level dextrose via the enteral route would stimulate intestinal incretin hormone production, potentiate insulin secretion in a glucose-dependent manner, and thereby improve glycemic control in the acute phase of sepsis. We administered IV or enteral dextrose to 10-week-old male C57BL/6J mice exposed to bacterial endotoxin and measured incretin hormone release, glucose disposal, and proinflammatory cytokine production. Compared with IV administration, enteral dextrose increased circulating levels of the incretin hormone glucose-dependent insulinotropic peptide (GIP) associated with increased insulin release and insulin sensitivity, improved mean arterial pressure, and decreased proinflammatory cytokines in endotoxemic mice. Exogenous GIP rescued glucose metabolism, improved blood pressure, and increased insulin release in endotoxemic mice receiving IV dextrose, whereas pharmacologic inhibition of GIP signaling abrogated the beneficial effects of enteral dextrose. Thus, stimulation of endogenous GIP secretion by early enteral dextrose maintains glucose homeostasis and attenuates the systemic inflammatory response in endotoxemic mice and may provide a therapeutic target for improving glycemic control and clinical outcomes in patients with sepsis.
Collapse
Affiliation(s)
- Faraaz Ali Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa.
| | - Srikanth Singamsetty
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Lanping Guo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Byron W Chuan
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | | | - Bryce A Cooper
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Brett J O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Darko Stefanovski
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Burton Wice
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University, St. Louis, Mo
| | - Yingze Zhang
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Christopher P O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Bryan J McVerry
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| |
Collapse
|
19
|
Hagar JA, Edin ML, Lih FB, Thurlow LR, Koller BH, Cairns BA, Zeldin DC, Miao EA. Lipopolysaccharide Potentiates Insulin-Driven Hypoglycemic Shock. THE JOURNAL OF IMMUNOLOGY 2017; 199:3634-3643. [PMID: 29038248 DOI: 10.4049/jimmunol.1700820] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/10/2017] [Indexed: 01/04/2023]
Abstract
Critically ill patients typically present with hyperglycemia. Treatment with conventional insulin therapy (targeting 144-180 mg/dl) improves patient survival; however, intensive insulin therapy (IIT) targeting normal blood glucose levels (81-108 mg/dl) increases the incidence of moderate and severe hypoglycemia, and increases mortality. Septic patients are especially prone to IIT-induced hypoglycemia, but the mechanism remains unknown. Here, we show that codelivery of insulin with otherwise sublethal doses of LPS induced hypoglycemic shock in mice within 1-2 h. LPS impaired clearance of insulin, which amplified insulin receptor signaling. These effects were mediated by caspase-11, TLR4, and complement, each of which trigger eicosanoid production that potentiates insulin signaling. Finally, in an animal model of sepsis, we observed that Salmonella typhimurium-infected mice exhibited simultaneous impaired insulin clearance coexisting with insulin resistance. Our results raise the possibility that septic patients have impaired insulin clearance, which could increase their susceptibility to hypoglycemia during IIT, contraindicating its use.
Collapse
Affiliation(s)
- Jon A Hagar
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Matthew L Edin
- Division of Intramural Research, National Institute for Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709
| | - Fred B Lih
- Division of Intramural Research, National Institute for Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709
| | - Lance R Thurlow
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15219
| | - Beverly H Koller
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Bruce A Cairns
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.,Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; and.,North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute for Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709
| | - Edward A Miao
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599; .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| |
Collapse
|
20
|
Diabetes Is Not Associated With Increased 90-Day Mortality Risk in Critically Ill Patients With Sepsis. Crit Care Med 2017; 45:e1026-e1035. [PMID: 28737575 DOI: 10.1097/ccm.0000000000002590] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine the association of pre-existing diabetes, hyperglycemia, and hypoglycemia during the first 24 hours of ICU admissions with 90-day mortality in patients with sepsis admitted to the ICU. DESIGN We used mixed effects logistic regression to analyze the association of diabetes, hyperglycemia, and hypoglycemia with 90-day mortality (n = 128,222). SETTING All ICUs in the Netherlands between January 2009 and 2014 that participated in the Dutch National Intensive Care Evaluation registry. PATIENTS All unplanned ICU admissions in patients with sepsis. INTERVENTIONS The association between 90-day mortality and pre-existing diabetes, hyperglycemia, and hypoglycemia, corrected for other factors, was analyzed using a generalized linear mixed effect model. MEASUREMENTS AND MAIN RESULTS In a multivariable analysis, diabetes was not associated with increased 90-day mortality. In diabetes patients, only severe hypoglycemia in the absence of hyperglycemia was associated with increased 90-day mortality (odds ratio, 2.95; 95% CI, 1.19-7.32), whereas in patients without pre-existing diabetes, several combinations of abnormal glucose levels were associated with increased 90-day mortality. CONCLUSIONS In the current retrospective large database review, diabetes was not associated with adjusted 90-day mortality risk in critically ill patients admitted with sepsis.
Collapse
|
21
|
Lu J, Wang X, Chen Q, Chen M, Cheng L, Jiang H, Sun Z. D-dimer Is a Predictor of 28-Day Mortality in Critically Ill Patients Receiving Continuous Renal Replacement Therapy. Arch Med Res 2017; 47:356-364. [PMID: 27751369 DOI: 10.1016/j.arcmed.2016.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 08/08/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Continuous renal replacement therapy (CRRT) is an important treatment in the intensive care unit (ICU). Nevertheless, the outcome of CRRT remains unclear. It is important to find a useful and easy indicator to predict the prognosis in patients on CRRT treatment. We undertook this study to observe the association between serum D-dimer level and mortality of ICU patients in the treatment of CRRT. METHODS A total of 149 patients who received CRRT were enrolled in our study. We observed the correlation of D-dimer with the information of biochemical parameters, acute physiology and chronic health evaluation II (APACHE II) score. We analyzed the association between serum D-dimer level before CRRT and 28-d mortality retrospectively. Furthermore, we used Cox regression analysis to assess whether D-dimer could be the independent risk factor for mortality. RESULTS There were significant correlations between D-dimer and C-reaction protein (r2 = 0.033, p = 0.026), creatinine (r2 = 0.066, p = 0.002) and APACHE II (r2 = 0.036, p = 0.021). The difference in 28-d mortality risk between elevated D-dimer group and normal D-dimer group was significant (HR 2.872, 95% CI 1.563-5.278, p = 0.001), and the elevated D-dimer level was an independent risk factor for 28-d mortality (HR 2.067, 95% CI 1.104-3.872, p = 0.023). The difference in 28-d mortality was significant between groups (p <0.001). ROC curves showed that the area under the curve (AUC) of D-dimer was 0.763. CONCLUSION The present study demonstrates that serum D-dimer could be a useful and easy prognostic variable of 28-d mortality in critically ill patients who received CRRT.
Collapse
Affiliation(s)
- Jun Lu
- Intensive Care Unit, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Xing Wang
- Intensive Care Unit, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Qiuhua Chen
- Intensive Care Unit, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Mingqi Chen
- Intensive Care Unit, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Lu Cheng
- Intensive Care Unit, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Hua Jiang
- Intensive Care Unit, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Zhiguang Sun
- The First Clinical College, Nanjing University of Traditional Chinese Medicine, Nanjing, China.
| |
Collapse
|
22
|
Kittah NE, Vella A. MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia. Eur J Endocrinol 2017; 177:R37-R47. [PMID: 28381450 DOI: 10.1530/eje-16-1062] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/15/2017] [Accepted: 04/05/2017] [Indexed: 01/03/2023]
Abstract
Glucose is the main substrate utilized by the brain and as such multiple regulatory mechanisms exist to maintain glucose concentrations. When these mechanisms fail or are defective, hypoglycemia ensues. Due to these robust mechanisms, hypoglycemia is uncommon and usually occurs in the setting of the treatment of diabetes using glucose-lowering agents such as sulfonylureas or insulin. The symptoms of hypoglycemia are non-specific and as such it is important to confirm hypoglycemia by establishing the presence of Whipple's triad before embarking on an evaluation for hypoglycemia. When possible, evaluation of hypoglycemia should be carried out at the time of spontaneous occurrence of symptoms. If this is not possible then one would want to create the circumstances under which symptoms occur. In cases where symptoms occur in the post absorptive state, a 72-h fast should be performed. Likewise, if symptoms occur after a meal then a mixed meal study may be the test of choice. The causes of endogenous hyperinsulinemic hypoglycemia include insulinoma, post-bariatric hypoglycemia and noninsulinoma pancreatogenous hypoglycemia syndrome. Autoimmune hypoglycemia syndrome is clinically and biochemically similar to insulinoma but associated with high levels of insulin antibodies and plasma insulin. Other important causes of hypoglycemia include medications, non-islet cell tumors, hormonal deficiencies, critical illness and factitious hypoglycemia. We provide an overview of the pathogenesis and management of hypoglycemia in these situations.
Collapse
Affiliation(s)
- Nana Esi Kittah
- Division of EndocrinologyDiabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Adrian Vella
- Division of EndocrinologyDiabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
23
|
Goh SNS, Yeoh E, Tan KY. Impact of perioperative hypoglycaemia in subjects with diabetes undergoing colorectal surgery. Int J Colorectal Dis 2017; 32:209-214. [PMID: 27864588 DOI: 10.1007/s00384-016-2680-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study explores the association between perioperative hypoglycaemia and surgical outcomes in subjects with diabetes, undergoing colorectal surgery. METHODS A retrospective review of 149 subjects with Type 2 Diabetes Mellitus (DM) who underwent colorectal surgery between 2010 and 2015 was performed. Perioperative glucose levels, glycated haemoglobin (HbA1c) measurements within 3 months of surgery and surgical complications based on Clavien-Dindo classification were analysed. RESULTS The mean age was 67 years (67 ± 11.2). Perioperative hypoglycaemia was found in 7.4% of subjects. The mean HbA1c of subjects with Clavien 2 and above surgical complications were higher than patients with Clavien 1 or no complications, Hba1c 7.6% (7.6 ± 2.5%) and 7.0% (7.0 ± 1.1%, p = 0.008), respectively. Similar findings in subjects with Clavien 3 and above complications, HbA1c of 8.2% (8.2 ± 3.9%) as compared to those with Clavien 2 and below complications, 7.2% (7.2 ± 1.5%, p = 0.001). Adjusted multivariate analysis showed that hypoglycaemia was significantly associated with Clavien 2 and above surgical complications, OR of 19.0 (CI 2.23-162, p = 0.007). Preoperative hypoglycaemia was associated with Clavien 2 and above surgical complications, OR 10.7 (CI 1.22-94.1, p = 0.032). Suboptimal glycaemic control (Hba1c >8.0%) was significantly associated with Clavien 2 and above complications, OR 2.48 (CI 1.04-5.91, p = 0.04), but not with Clavien 3 and above complications, OR 1.50 (CI 0.450-4.98, p = 0.511). CONCLUSION Perioperative hypoglycaemia is associated with adverse surgical outcomes in diabetic patients undergoing colorectal surgery. Prevention of hypoglycaemia may improve surgical outcomes. HbA1c is an independent predictor for adverse surgical outcomes.
Collapse
Affiliation(s)
- Si Ning Serene Goh
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
| | - Ester Yeoh
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| |
Collapse
|
24
|
Johnston LE, Kirby JL, Downs EA, LaPar DJ, Ghanta RK, Ailawadi G, Kozower BD, Kron IL, McCall AL, Isbell JM. Postoperative Hypoglycemia Is Associated With Worse Outcomes After Cardiac Operations. Ann Thorac Surg 2016; 103:526-532. [PMID: 27570164 DOI: 10.1016/j.athoracsur.2016.05.121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/25/2016] [Accepted: 05/27/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hypoglycemia is a known risk of intensive postoperative glucose control in patients undergoing cardiac operations. However, neither the consequences of hypoglycemia relative to hyperglycemia, nor the possible interaction effects, have been well described. We examined the effects of postoperative hypoglycemia, hyperglycemia, and their interaction on short-term morbidity and mortality. METHODS Single-institution Society of Thoracic Surgeons (STS) database patient records from 2010 to 2014 were merged with clinical data, including blood glucose values measured in the intensive care unit (ICU). Exclusion criteria included fewer than three glucose measurements and absence of an STS predicted risk of morbidity or mortality score. Primary outcomes were operative mortality and composite major morbidity (permanent stroke, renal failure, prolonged ventilation, pneumonia, or myocardial infarction). Secondary outcomes included ICU and postoperative length of stay. Hypoglycemia was defined as below 70 mg/dL, and hyperglycemia as above 180 mg/dL. Simple and multivariable regression models were used to evaluate the outcomes. RESULTS A total of 2,285 patient records met the selection criteria for analysis. The mean postoperative glucose level was 140.8 ± 18.8 mg/dL. Overall, 21.4% of patients experienced a hypoglycemic episode (n = 488), and 1.05% (n = 24) had a severe hypoglycemic episode (<40 mg/dL). The unadjusted odds ratio (UOR) for operative mortality for patients with any hypoglycemic episode compared with those without was 5.47 (95% confidence interval [CI] 3.14 to 9.54), and the UOR for major morbidity was 4.66 (95% CI 3.55 to 6.11). After adjustment for predicted risk of morbidity or mortality and other significant covariates, the adjusted odds (AOR) of operative mortality were significant for patients with any hypoglycemia (AOR 4.88, 95% CI 2.67 to 8.92) and patients with both events (AOR 8.29, 95% CI 1.83 to 37.5) but not hyperglycemia alone (AOR 1.62, 95% CI 0.56 to 4.69). The AOR of major morbidity for patients with both hypoglycemic and hyperglycemic events was 14.3 (95% CI 6.50 to 31.4). CONCLUSIONS Postoperative hypoglycemia is associated with both mortality and major morbidity after cardiac operations. The combination of both hyperglycemia and hypoglycemia represents a substantial increase in risk. Although it remains unclear whether hypoglycemia is a cause, an early warning sign, or a result of adverse events, this study suggests that hypoglycemia may be an important event in the postoperative period after cardiac operations.
Collapse
Affiliation(s)
- Lily E Johnston
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jennifer L Kirby
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Emily A Downs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Damien J LaPar
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Ravi K Ghanta
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Benjamin D Kozower
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Irving L Kron
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Anthony L McCall
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - James M Isbell
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | | |
Collapse
|
25
|
Taranukhin AG, Saransaari P, Kiianmaa K, Oja SS. Hypoglycemia is one possible mechanism in the combined toxicity of ethanol and taurine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 803:305-12. [PMID: 25833506 DOI: 10.1007/978-3-319-15126-7_24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
26
|
Garazi E, Bridge S, Caffarelli A, Ruoss S, Van der Starre P. Acute Cellular Insulin Resistance and Hyperglycemia Associated with Hypophosphatemia After Cardiac Surgery. ACTA ACUST UNITED AC 2015; 4:22-5. [DOI: 10.1213/xaa.0000000000000112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
27
|
Intensive insulin therapy for septic patients: a meta-analysis of randomized controlled trials. BIOMED RESEARCH INTERNATIONAL 2014; 2014:698265. [PMID: 25136614 PMCID: PMC4086473 DOI: 10.1155/2014/698265] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/18/2014] [Indexed: 02/07/2023]
Abstract
Background. Studies on the effect of intensive insulin therapy (IIT) in septic patients with hyperglycemia have given inconsistent results. The primary purpose of this meta-analysis was to evaluate whether it is effective in reducing mortality. Methods. We searched PubMed, Embase, the Cochrane Library, clinicaltrials.gov, and relevant reference lists up to September 2013 and including randomized controlled trials that compared IIT with conventional glucose management in septic patients. Study quality was assessed using the Cochrane Risk of Bias Tool. And our primary outcome measure was pooled in the random effects model. Results. We identified twelve randomized controlled trials involving 4100 patients. Meta-analysis showed that IIT did not reduce any of the outcomes: overall mortality (risk ratio [RR] = 0.98, 95% CI [0.85, 1.15], P = 0.84), 28-day mortality (RR = 0.66, 95% CI [0.40, 1.10], P = 0.11), 90-day mortality (RR = 1.10, 95% CI [0.97, 1.26], P = 0.13), ICU mortality (RR = 0.94, 95% CI [0.77, 1.14], P = 0.52), hospital mortality (RR = 0.98, 95% CI [0.86, 1.11], P = 0.71), severity of illness, and length of ICU stay. Conversely, the incidence of hypoglycemia was markedly higher in the IIT (RR = 2.93, 95% CI [1.69, 5.06], P = 0.0001). Conclusions. For patients with sepsis, IIT and conservative glucose management show similar efficacy, but ITT is associated with a higher incidence of hypoglycemia.
Collapse
|
28
|
Oud L, Spellman C. The Association of Glucose Variability and Home Discharge Among Survivors of Critical Illness Managed With a Computerized Decision-Support Tool for Glycemic Control. J Diabetes Sci Technol 2014; 8:277-285. [PMID: 24876579 PMCID: PMC4455424 DOI: 10.1177/1932296813518136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In-intensive care unit (ICU) glucose variability (GV) is associated with increased mortality. However, the impact of GV on hospital survivors' morbidity and associated changes in destination at time of hospital discharge are unknown. We studied a retrospective patient cohort in a medical/surgical ICU, requiring insulin infusion, using computer-guided insulin dosing software. Standard deviation (GluSD) and coefficient of variation (GluCV) were used as GV measures. We examined rates of home discharge (H) in the whole cohort and selected subgroups across GV quartiles, between patients with and without H, determinants of H, and determinants of GV and its association with patients' ICU length of stay (LOS). A total of 351 patients met study criteria. The association of GV and H varied among examined subgroups. H increased with GV quartile (GluSD; P = .004). GV was higher in patients with H than non-H (GluSD 36.1 vs 30.0 mg/dl, respectively; P = .002). Increased GV was not a predictor of reduced H on multivariate analysis. GV was inversely associated with patients' ICU LOS in all examined subgroups. Increased number of hypoglycemic events and time to attain target glycemia were independent predictors of reduced H. GV was not associated with adverse impact on H in the present cohort, and its prognostic impact should be considered in the context of ICU LOS of examined patient populations. Further studies are needed to examine the morbidity effects of GV and other glycemia-related measures among hospital survivors of critical illness across varying ICU populations, glycemic control approaches, and glycemic targets.
Collapse
Affiliation(s)
- Lavi Oud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University HSC, Odessa, TX, USA
| | - Craig Spellman
- Division of Endocrinology, Department of Internal Medicine, Texas Tech University HSC, Odessa, TX, USA
| |
Collapse
|
29
|
Marik PE, Bellomo R. Stress hyperglycemia: an essential survival response! CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:305. [PMID: 23470218 PMCID: PMC3672537 DOI: 10.1186/cc12514] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Stress hyperglycemia is common in critically ill patients and appears to be a marker of disease severity. Furthermore, both the admission as well as the mean glucose level during the hospital stay is strongly associated with patient outcomes. Clinicians, researchers and policy makers have assumed this association to be causal with the widespread adoption of protocols and programs for tight in-hospital glycemic control. However, a critical appraisal of the literature has demonstrated that attempts at tight glycemic control in both ICU and non-ICU patients do not improve health care outcomes. We suggest that hyperglycemia and insulin resistance in the setting of acute illness is an evolutionarily preserved adaptive responsive that increases the host's chances of survival. Furthermore, attempts to interfere with this exceedingly complex multi-system adaptive response may be harmful. This paper reviews the pathophysiology of stress hyperglycemia and insulin resistance and the protective role of stress hyperglycemia during acute illness.
Collapse
|