Acute Glucose Elevation Is Highly Predictive of Infection and Outcome in Critically Injured Trauma Patients

Bochicchio, Grant V.; Bochicchio, Kelly; Joshi, Manjari; Ilahi, Obeid; Scalea, Thomas M.

doi:10.1097/sla.0b013e3181f4e499

Cited by 49 publications

(50 citation statements)

References 31 publications

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“…In this study, the occurrence of hyperglycemia during the inductive chemotherapy did not significantly affect the CR rate of children (compared with the euglycemia group, 86.8% vs 95%, P=0.134), while the prognosis of the hyperglycemia group was poorer, the 5-year overall survival rate was significantly lower than the euglycemia group (83.1±6.3% vs 94.2±2.9%, P=0.014), the 5 -year relapse-free rate was also significantly lower than the euglycemia group (64.1±8.9% vs 88.6±3.8%, P<0.001). Several studies of adults had shown that the hyperglycemia could predict the higher mortality, the mean fasting blood glucose >112.5 mg/dl could significantly increase the mortality of cancer patients (Bochicchio et al, 2010;Seshasai et al, 2011), and the appearance of hyperglycemia in the inductive chemotherapy of adult ALL patients exhibited the poor prognosis, compared with the euglycemic patients, the risks of the early recurrence and higher mortality were 1.57 times and 1.71 times, respectively, with shorter median CR (24 months vs 52 months, P=0.001) and median survival time (29 months vs 88 months, P<0.001) (Weiser et al, 2004). currently, there were three research institutions that reported the relationship of hyperglycemia during the inductive remission with the childhood ALL, while the results were different .…”

Section: Discussionmentioning

confidence: 99%

Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic Leukemia

Zhang

Wang²,

Hou³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Purpose: To investigate the impact of hyperglycemia during inductive treatment on the prognosis of acute lymphocytic leukemia (ALL) in children. Materials and Methods: Clinical data of 159 ALL childhood cases were reviewed. The patients were divided into the hyperglycemia group (fasting glucose≥126mg/dl and/or random blood glucose≥200mg/dl) and the euglycemia group according to the blood glucose values. The Χ2 test was performed to compare the complete remission rates of the two groups, and Kaplan-Meier and log-rank tests were performed to compare the 5-year overall and relapse-free survival. Results: The incidence of hyperglycemia in the age≥10-year-old group was higher than the younger-age group (P=0.009). Values in the interim-and high-risk groups were higher than the standard-risk group (P=0.028), while there was no significant difference between genders (P=0.056). The complete remission rates of the 2 groups demonstrated no significant difference (P=0.134), while the 5-year OS of the hyperglycemia group was lower than in the euglycemia group (83.8±6.0% vs 94.9±2.4%, P=0.014). The 5 -year RFS was significantly lower than the euglycemia group (62.9±8.7%) vs 80.2±9.1%, P<0.001). Conclusions: Children with age≥10 years old, and in the middle-and high-risk groups appear prone to complicating hyperglycemia during inductive chemotherapy, associated with lower 5-year OS and RFS.Keywords: Childhood ALL -chemotherapy-related hyperglycemia -relapse-free rate -overall survival RESEARCH ARTICLE Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic LeukemiaBi-Hong Zhang 1 , Jian Wang 1 , Hong-Man Xue, Chun Chen* the L-asparaginase (L-asp) and glucocorticoids are the commonly used drugs during the child ALL inductive chemotherapy, which would affect the production, release and functions of insulin, the chemotherapy-related hyperglycemia is also a common complication of child ALL, with the occurring rate as 4% to 20%, or even as high as 56% (Belgaumi et al., 2003;Sonabend et al., 2008). Currently, the report about the impacts of hyperglycemia during the inductive chemotherapy towards the prognosis of child ALL is few, and the conclusions are inconsistent. This study compares the rates of complete remission, 5-year recurrence-free survival and 5-year overall survival between the hyperglycemic ALL children and the non-hyperglycemic ALL children during the inductive chemotherapy, aiming to analyze the relationship of hyperglycemia and prognosis of child ALL.

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Section: Discussionmentioning

confidence: 99%

Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic Leukemia

Zhang

Wang²,

Hou³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…This was associated with greater in-hospital mortality, longer hospital stays, and increased rates of admission to the ICU. Additionally, the general trauma and critical care literature is replete with investigations on the relationship of hyperglycemia with morbidity and mortality following critical illness [9][10][11][12]15,16 , with some authors suggesting that ongoing persistent hyperglycemia and subsequent glucose control are predictive of outcome 21,24 . However, this has not been easily translated into results that may be applied in an environment outside of an ICU.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Hyperglycemia and Surgical-Site Infection in Orthopaedic Surgery

Richards

Kauffmann

Zuckerman

et al. 2012

The Journal of Bone & Joint Surgery

178

105

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“…In addition, early posttrauma hyperglycemia has been found to be a more reliable predictor of poor outcomes and mortality compared with later increases in plasma glucose (7,16). Hyperglycemia has been shown to increase ROS and affect neutrophil responses, including neutrophil retention (27) and exacerbated free radical release (28), which are important processes in innate immune responses (22,49) and ALI.…”

Section: Significance and Clinical Relevancementioning

confidence: 99%

“…Several clinical studies have suggested that, in critically ill obese patients, impaired glucose homeostasis appears to be a better predictor of increased complications and mortality than body mass index (38,41,45). In addition, there is evidence that the early hyperglycemia within the first day after trauma is a more reliable predictor of poor outcomes and mortality compared with later increases in plasma glucose (7,16). A study (45) monitoring glucose levels for 4 days after trauma showed that nonsurvivors only exhibited a significant increase in glucose (Ͼ150 mg/dl) within the first half day after trauma, with peak levels observed at admission.…”

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confidence: 98%

“…We have previously shown that, compared with LZ rats, OZ exhibit exacerbated systemic inflammation and acute lung injury (ALI) after severe trauma (48). Given that early posttrauma hyperglycemia is a predictor of adverse outcomes (7,16,45), we hypothesized that OZ rats exhibit a greater increase in early posttrauma glucose compared with LZ rats, with the increased posttrauma hyperglycemia suppressed by ICI treatment. …”

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confidence: 99%

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β₂-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats

Xiang

Mittwede

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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Xiang L, Lu S, Mittwede PN, Clemmer JS, Husband GW, Hester RL. ␤ 2-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats. Am J Physiol Heart Circ Physiol 307: H621-H627, 2014. First published June 14, 2014; doi:10.1152/ajpheart.00208.2014.-Early hyperglycemia after trauma increases morbidity and mortality. Insulin is widely used to control posttrauma glucose, but this treatment increases the risk of hypoglycemia. We tested a novel method for early posttrauma hyperglycemia control by suppressing hepatic glycogenolysis via ␤ 2-adrenoreceptor blockade [ICI-118551 (ICI)]. We have shown that, after severe trauma, obese Zucker (OZ) rats, similar to obese patients, exhibit increased acute lung injury compared with lean Zucker (LZ) rats. We hypothesized that OZ rats exhibit a greater increase in early posttrauma glucose compared with LZ rats, with the increased posttrauma hyperglycemia suppressed by ICI treatment. Orthopedic trauma was applied to both hindlimbs in LZ and OZ rats. Fasting plasma glucose was then monitored for 6 h with or without ICI (0.2 mg·kg Ϫ1 ·h Ϫ1 iv.) treatment. One day after trauma, plasma IL-6 levels, lung neutrophil numbers, myeloperoxidase (MPO) activity, and wetto-dry weight ratios were measured. Trauma induced rapid hepatic glycogenolysis, as evidenced by decreased liver glycogen levels, and this was inhibited by ICI treatment. Compared with LZ rats, OZ rats exhibited higher posttrauma glucose, IL-6, lung neutrophil infiltration, and MPO activity. Lung wet-to-dry weight ratios were increased in OZ rats but not in LZ rats. ICI treatment reduced the early hyperglycemia, lung neutrophil retention, MPO activity, and wet-to-dry weight ratio in OZ rats to levels comparable with those seen in LZ rats, with no effect on blood pressure or heart rate. These results demonstrate that ␤ 2-adrenoreceptor blockade effectively reduces the early posttrauma hyperglycemia, which is associated with decreased lung injury in OZ rats. obesity; trauma; glucose; lung injury; ␤ 2-adrenoreceptor UNINTENTIONAL INJURIES are the leading cause of mortality in individuals under 50 yr of age in the United States, with staggering medical expenses attributable to traumatic injury (10a, 43). Obese patients with severe orthopedic trauma are at a higher risk than lean patients for increased inflammation, multiorgan failure, prolonged hospital stay, and increased mortality (5,8,10,12). Although the mechanisms responsible for the increased posttrauma complications in obese patients are unclear, intensive and specific treatments have been emphasized for these patients.Posttrauma hyperglycemia has been recognized as a risk factor that exacerbates complications, organ dysfunction, and mortality (29,41,44). Several clinical studies have suggested that, in critically ill obese patients, impaired glucose homeostasis appears to be a better predictor of increased complications and mortality than body mass index (38,41,45). In addition, there is evidence that the early hyperglycemia within the f...

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Acute Glucose Elevation Is Highly Predictive of Infection and Outcome in Critically Injured Trauma Patients

Abstract: AGE is a highly accurate predictor of infection and should stimulate clinicians to identify a new source of infection.

Cited by 49 publications

References 31 publications

Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic Leukemia

Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic Leukemia

Relationship of Hyperglycemia and Surgical-Site Infection in Orthopaedic Surgery

β₂-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats

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Acute Glucose Elevation Is Highly Predictive of Infection and Outcome in Critically Injured Trauma Patients

Abstract: AGE is a highly accurate predictor of infection and should stimulate clinicians to identify a new source of infection.

Cited by 49 publications

References 31 publications

Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic Leukemia

Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic Leukemia

Relationship of Hyperglycemia and Surgical-Site Infection in Orthopaedic Surgery

β2-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats

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Product

Resources

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β₂-Adrenoreceptor blockade improves early posttrauma hyperglycemia and pulmonary injury in obese rats