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Grigonyte-Daraskeviciene M, Møller MH, Kaas-Hansen BS, Bestle MH, Nielsen CG, Perner A. Glucose evaluation and management in the ICU (GEM-ICU): Protocol for a bi-centre cohort study. Acta Anaesthesiol Scand 2024. [PMID: 38898601 DOI: 10.1111/aas.14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Hyperglycaemia is common in intensive care unit (ICU) patients. Glycaemic monitoring and effective glycaemic control with insulin are crucial in the ICU to improve patient outcomes. However, glycaemic control and insulin use vary between ICU patients and hypo- and hyperglycaemia occurs. Therefore, we aim to provide contemporary data on glycaemic control and management, and associated outcomes, in adult ICU patients. We hypothesise that the occurrence of hypoglycaemia in acutely admitted ICU patients is lower than that of hyperglycaemia. METHODS We will conduct a bi-centre cohort study of 300 acutely admitted adult ICU patients. Routine data will be collected retrospectively at baseline (ICU admission) and daily during ICU stay up to a maximum of 30 days. The primary outcome will be the number of patients with hypoglycaemia during their ICU stay. Secondary outcomes will be occurrence of severe hypoglycaemia, occurrence of hyperglycaemia, time below blood glucose target range, time above target range, all-cause mortality at Day 30, number of days alive without life support at Day 30 and number of days alive and out of hospital at Day 30. Process outcomes include the number of in-ICU days, glucose measurements (number of measurements and method) and use of insulin (including route of administration and dosage). All statistical analyses will be descriptive. CONCLUSIONS This cohort study will provide a contemporary overview of glucose evaluation and management practices in adult ICU patients and, thus, highlight potential areas for improvement through future clinical trials in this area.
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Affiliation(s)
- Milda Grigonyte-Daraskeviciene
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Benjamin Skov Kaas-Hansen
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Heiberg Bestle
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - Christian Gantzel Nielsen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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See KC. Metformin-associated lactic acidosis: A mini review of pathophysiology, diagnosis and management in critically ill patients. World J Diabetes 2024; 15:1178-1186. [PMID: 38983827 PMCID: PMC11229964 DOI: 10.4239/wjd.v15.i6.1178] [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: 12/24/2023] [Revised: 04/04/2024] [Accepted: 04/23/2024] [Indexed: 06/11/2024] Open
Abstract
Metformin is a common diabetes drug that may reduce lactate clearance by inhibiting mitochondrial oxidative phosphorylation, leading to metformin-associated lactic acidosis (MALA). As diabetes mellitus is a common chronic metabolic condition found in critically ill patients, pre-existing metformin use can often be found in critically ill patients admitted to the intensive care unit or the high dependency unit. The aim of this narrative mini review is therefore to update clinicians about MALA, and to provide a practical approach to its diagnosis and treatment. MALA in critically ill patients may be suspected in a patient who has received metformin and who has a high anion gap metabolic acidosis, and confirmed when lactate exceeds 5 mmol/L. Risk factors include those that reduce renal elimination of metformin (renal impairment from any cause, histamine-2 receptor antagonists, ribociclib) and excessive alcohol consumption (as ethanol oxidation consumes nicotinamide adenine dinucleotides that are also required for lactate metabolism). Treatment of MALA involves immediate cessation of metformin, supportive management, treating other concurrent causes of lactic acidosis like sepsis, and treating any coexisting diabetic ketoacidosis. Severe MALA requires extracorporeal removal of metformin with either intermittent hemodialysis or continuous kidney replacement therapy. The optimal time to restart metformin has not been well-studied. It is nonetheless reasonable to first ensure that lactic acidosis has resolved, and then recheck the kidney function post-recovery from critical illness, ensuring that the estimated glomerular filtration rate is 30 mL/min/1.73 m2 or better before restarting metformin.
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Affiliation(s)
- Kay Choong See
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
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Chalkias A, Adamos G, Mentzelopoulos SD. General Critical Care, Temperature Control, and End-of-Life Decision Making in Patients Resuscitated from Cardiac Arrest. J Clin Med 2023; 12:4118. [PMID: 37373812 DOI: 10.3390/jcm12124118] [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: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Cardiac arrest affects millions of people per year worldwide. Although advances in cardiopulmonary resuscitation and intensive care have improved outcomes over time, neurologic impairment and multiple organ dysfunction continue to be associated with a high mortality rate. The pathophysiologic mechanisms underlying the post-resuscitation disease are complex, and a coordinated, evidence-based approach to post-resuscitation care has significant potential to improve survival. Critical care management of patients resuscitated from cardiac arrest focuses on the identification and treatment of the underlying cause(s), hemodynamic and respiratory support, organ protection, and active temperature control. This review provides a state-of-the-art appraisal of critical care management of the post-cardiac arrest patient.
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Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece
- Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Georgios Adamos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, 10675 Athens, Greece
| | - Spyros D Mentzelopoulos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, 10675 Athens, Greece
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Guarino M, Perna B, Cesaro AE, Maritati M, Spampinato MD, Contini C, De Giorgio R. 2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department. J Clin Med 2023; 12:jcm12093188. [PMID: 37176628 PMCID: PMC10179263 DOI: 10.3390/jcm12093188] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Sepsis/septic shock is a life-threatening and time-dependent condition that requires timely management to reduce mortality. This review aims to update physicians with regard to the main pillars of treatment for this insidious condition. METHODS PubMed, Scopus, and EMBASE were searched from inception with special attention paid to November 2021-January 2023. RESULTS The management of sepsis/septic shock is challenging and involves different pathophysiological aspects, encompassing empirical antimicrobial treatment (which is promptly administered after microbial tests), fluid (crystalloids) replacement (to be established according to fluid tolerance and fluid responsiveness), and vasoactive agents (e.g., norepinephrine (NE)), which are employed to maintain mean arterial pressure above 65 mmHg and reduce the risk of fluid overload. In cases of refractory shock, vasopressin (rather than epinephrine) should be combined with NE to reach an acceptable level of pressure control. If mechanical ventilation is indicated, the tidal volume should be reduced from 10 to 6 mL/kg. Heparin is administered to prevent venous thromboembolism, and glycemic control is recommended. The efficacy of other treatments (e.g., proton-pump inhibitors, sodium bicarbonate, etc.) is largely debated, and such treatments might be used on a case-to-case basis. CONCLUSIONS The management of sepsis/septic shock has significantly progressed in the last few years. Improving knowledge of the main therapeutic cornerstones of this challenging condition is crucial to achieve better patient outcomes.
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Affiliation(s)
- Matteo Guarino
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Benedetta Perna
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Alice Eleonora Cesaro
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Martina Maritati
- Infectious and Dermatology Diseases, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Michele Domenico Spampinato
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Carlo Contini
- Infectious and Dermatology Diseases, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44121 Ferrara, Italy
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See KC, Lau YH. Acute management of pneumonia in adult patients. Singapore Med J 2023; 64:209-216. [PMID: 36876626 PMCID: PMC10071852 DOI: 10.4103/singaporemedj.smj-2022-050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Affiliation(s)
- Kay Choong See
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore
| | - Yie Hui Lau
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
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Choi KY, Lee HJ, Lee HW, Park TY, Heo EY, Kim DK, Lee JK. Systemic corticosteroid use and cardiovascular risk in patients hospitalized for pneumonia. Steroids 2023; 191:109161. [PMID: 36572057 DOI: 10.1016/j.steroids.2022.109161] [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: 07/04/2022] [Revised: 11/30/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Limited data are available concerning cardiovascular risk with respect to adjunctive corticosteroid use in patients with pneumonia. We aimed to assess the associations between systemic corticosteroid use and the occurrence of major adverse cardiovascular events (MACEs) in patients hospitalized for pneumonia. METHODS Among study participants enrolled via surveillance for severe acute respiratory infection from July 2016 to January 2017, the clinical course of patients with pneumonia was retrospectively investigated until December 2019. We evaluated the occurrence of in-hospital and after-discharge MACEs according to steroid use during hospitalization. RESULTS Of the 424 patients hospitalized for pneumonia, 118 (28.8%) received systemic corticosteroids during hospitalization. The most common reason for steroid use was acute exacerbation of chronic lung disease (75.4%). Systemic steroid use was significantly associated with an increased risk of in-hospital MACEs; it was not associated with after-discharge MACEs. The risk of in-hospital MACEs was significantly greater in patients with more comorbidities, more severe pneumonia, and a higher inflammatory marker level; moreover, it was positively associated with duration and cumulative dose of steroid treatment. CONCLUSION Systemic corticosteroid use was associated with an increased risk of in-hospital MACEs in patients hospitalized for pneumonia.
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Affiliation(s)
- Kwang Yong Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyo Jin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
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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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Lin J, Cai C, Xie Y. Acute Glycemic Variability and Functional Outcome in Patients with Acute Ischemic Stroke: A Meta-Analysis. Horm Metab Res 2022; 54:371-379. [PMID: 35697046 DOI: 10.1055/a-1837-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Dysglycemia are involved in the development of functional impairment after acute ischemic stroke (AIS). The aim of the study was to evaluate the association between acute glycemic variability and functional outcome in patients with AIS. Cohort studies were obtained by search Medline, Web of Science, Embase, Wanfang, and China National Knowledge Infrastructure databases from inception to November, 2021. A random-effect model which incorporates the intra-study heterogeneity was chosen to pool the results. Ten cohort studies including 3038 patients were included, and 1319 (43.4%) had poor functional outcome (modified Rankin Scale >2) up to three months after disease onset. Pooled results showed that higher acute GV was associated with an increased risk of poor functional outcome, as evidenced by GV evaluated by the standard deviation of blood glucose (SDBG, OR: 1.91, 95% CI: 1.38 to 2.65, I2=60%, p<0.001), the coefficient of variation of blood glucose (OR: 2.03, 95% CI: 1.15 to 3.58, I2=17%, p=0.02), the range of glucose (OR: 1.43, 95% CI: 1.11 to 1.83, I2=22%, p=0.005), and the mean amplitude of glycemic excursion (OR: 1.59, 95% CI: 1.10 to 2.31, I2=0%, p=0.01). Subgroup analyses did not support that difference in study design, treatments for AIS, mean age of the patients, duration for GV measuring, or study quality would significantly affect the association between SDBG and functional outcome after AIS. In conclusion, higher acute glycemic variability may predict poor functional outcome within 3 months after AIS.
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Affiliation(s)
- Jinbo Lin
- Department of Neurology, Huizhou First Hospital, Huizhou, China
| | - Chunsheng Cai
- Department of Neurology, Huizhou First Hospital, Huizhou, China
| | - Yituan Xie
- Department of Neurology, Huizhou First Hospital, Huizhou, China
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Chalkias A, Laou E, Mermiri M, Michou A, Ntalarizou N, Koutsona S, Chasiotis G, Garoufalis G, Agorogiannis V, Kyriakaki A, Papagiannakis N. Microcirculation-guided treatment improves tissue perfusion and hemodynamic coherence in surgical patients with septic shock. Eur J Trauma Emerg Surg 2022; 48:4699-4711. [PMID: 35606577 DOI: 10.1007/s00068-022-01991-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Severe sepsis and septic shock may impair microcirculatory perfusion and cause organ dysfunction. The aim of this pilot study was to assess a new microcirculation-guided resuscitation strategy in patients with septic shock undergoing emergency abdominal surgery. METHODS A microcirculation-guided treatment algorithm was developed and applied intraoperatively following restoration of systemic hemodynamics. Sublingual microcirculation was monitored with Sidestream DarkField (SDF +) imaging technique. The primary objective was to investigate the change in De Backer score, Consensus Proportion of Perfused Vessels (Consensus PPV), and Consensus PPV (small) and its association with venous-to-arterial carbon dioxide difference (v-aPCO2). RESULTS Thirteen consecutive patients were included in the study. Microcirculation-guided resuscitation resulted in an increase of 0.49 mm-1 in the De Backer score (p < 0.001), an increase of 2.28% in the Consensus PPV (p < 0.001), and an increase of 2.26% in the Consensus PPV (small) (p < 0.001) for every 30 min of additional intraoperative time. All microcirculation variables were negatively correlated with v-aPCO2 (rho = - 0.656, adj-p < 0.001; rho = - 0.623; adj-p < 0.001; rho = - 0.597, adj-p < 0.001, respectively) at each intraoperative time point. Lactate levels were negatively correlated with Consensus PPV (rho = - 0.464; adj-p = 0.002) and Consensus PPV (small) (rho = - 0.391, adj-p < 0.001). Survival at 30 days, 90 days, and 1 year were 76.9%, 76.9%, and 61.5%, respectively. CONCLUSIONS The intraoperative use of microcirculation-guided resuscitation strategy may improve tissue perfusion and hemodynamic coherence in patients with septic shock.
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Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece. .,Outcomes Research Consortium, Cleveland, OH, 44195, USA. .,Committee on Shock, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece. .,Department of Anesthesiology, University Hospital of Larisa, Biopolis, Mezourlo, 41110, Larisa, Greece.
| | - Eleni Laou
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Maria Mermiri
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Anastasia Michou
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Nicoleta Ntalarizou
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Stamatia Koutsona
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Georgios Chasiotis
- Department of Urology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Grigorios Garoufalis
- Department of General Surgery, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Vasileios Agorogiannis
- Department of General Surgery, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Aikaterini Kyriakaki
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Nikolaos Papagiannakis
- First Department of Neurology, Medical School, Aiginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Lin J, Cai C, Xie Y, Yi L. Acute glycemic variability and mortality of patients with acute stroke: a meta-analysis. Diabetol Metab Syndr 2022; 14:69. [PMID: 35538585 PMCID: PMC9092773 DOI: 10.1186/s13098-022-00826-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/04/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Increased glucose fluctuation has been related to poor prognosis in patients with critical illnesses, while its prognostic role in patients with acute stroke remains unknown. The meta-analysis aimed to evaluate the association between the acute glycemic variation (GV) and mortality risk in patients with acute stroke. METHODS Cohort studies were obtained by searching Medline, Web of Science, Embase, Wanfang and CNKI databases. A random-effect model which incorporates the intra-study heterogeneity was chosen to pool the results. RESULTS Ten cohort studies with 1433 patients were included, and 280 (19.5%) of them died within 90 days of disease onset. Results of the meta-analyses showed that a higher acute GV was associated with an increased risk of early mortality in patients with acute stroke, as indicated by GV measured with the coefficient of variation of blood glucose (CVBG, odds ratio [OR]: 2.24, 95% CI 1.40 to 3.58, p < 0.001, I2 = 73%), the standard deviation of blood glucose (SDBG, OR: 2.31, 95% CI 1.70 to 3.13, p < 0.001, I2 = 50%), and the mean amplitude of glycemic excursion (OR: 3.57, 95% CI 1.44 to 8.85, p = 0.006, I2 = 23%). For acute GV measured with CVBG and SDBG, subgroup analyses showed consistent results in patients with acute ischemic and hemorrhagic stroke, and for studies reporting 28-day and 90-day all-cause mortality (p for subgroup analysis all > 0.05). CONCLUSIONS Higher acute GV may be an independent risk factor of early mortality in patients with acute stroke.
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Affiliation(s)
- Jinbo Lin
- Department of Neurology, Huizhou First Hospital, Huizhou, 516000, China
| | - Chunsheng Cai
- Department of Neurology, Huizhou First Hospital, Huizhou, 516000, China
| | - Yituan Xie
- Department of Neurology, Huizhou First Hospital, Huizhou, 516000, China
| | - Li Yi
- Department of Neurology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, 518000, China.
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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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