Admission Plasma Glucose

Zindrou, Dlear; Taylor, Kenneth M.; Bagger, Jens Peder

doi:10.2337/diacare.24.9.1634

Cited by 67 publications

(25 citation statements)

References 23 publications

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“…In a retrospective study of 200 patients who underwent CABG surgery, Fish et al (9), using a postoperative blood glucose cut-off level of 11.1 mmol/L to identify diabetes, reported a threefold increase in complications associated with hyper glycemia. In another study of 878 previously nondiabetic patients undergoing CABG surgery, Zindrou et al (12) reported that in women, an admission SG level of greater than 6 mmol/L was predictive of increased 30-day mortality. This study did not assess the longterm outcomes of these patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of admission serum glucose level on in-hospital outcomes following coronary artery bypass grafting surgery

Imran¹,

Ransom²,

Buth

et al. 2010

Canadian Journal of Cardiology

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I t has been confirmed that serum glucose (SG) levels are independently associated with both short-and long-term outcomes of patients with cardiovascular disease (1). In the setting of an acute myocardial infarction, hyperglycemia enhances the risk of morbidity and mortality independent of the patients' diabetes status (2). Hyperglycemia is also highly predictive of the occurrence of left ventricular failure and cardiac death in patients with acute coronary syndrome (3,4), and is associated with larger infarct size, worse functional recovery and higher long-term mortality in patients undergoing reperfusion with either thrombolysis or percutaneous coronary intervention (5,6).In patients undergoing cardiac surgery, there is also evidence that both intraoperative (7,8) and postoperative (9) SG levels predict the occurrence of adverse postoperative events. Tight control of intra-and postoperative SG levels with insulin increases survival and decreases the incidence of ischemic events in diabetic patients undergoing coronary artery bypass grafting (CABG) surgery (10).In contrast to the known importance of intra-and/or postoperative SG levels on the outcomes of CABG surgery, there exists a paucity of data regarding the potential impact of preoperative or admission SG level on the outcomes of cardiac surgery. We hypothesized that an elevated preoperative or admission SG level would be an independent clInIcal studIes ©2010 Pulsus Group Inc. All rights reserved OBJECTIVE:The impact of admission serum glucose (SG) level on outcomes in coronary artery bypass grafting (CABG) surgery is unknown. The present study sought to determine whether elevated admission SG level is associated with adverse outcomes following CABG surgery. METHODS: Patients undergoing CABG surgery between January 2000and December 2005 at a single centre were identified (n=2856). Admission SG levels of less than 9.2 mmol/L and 9.2 mmol/L or greater were chosen to divide patients into two groups based on the 75th percentile of SG distribution. A logistic regression model was generated to determine the impact of admission SG level on a composite outcome of any one or more of in-hospital mortality, stroke, perioperative myocardial infarction, sepsis, deep sternal wound infection, renal failure, requirement for postoperative inotropes and prolonged ventilation. RESULTS: In total, 76.3% of patients had an admission SG level of less than 9.2 mmol/L (group A) and 23.7% had an admission SG level of 9.2 mmol/L or greater (group B). Group B patients were more likely to be female, have diabetes, have preoperative renal failure, have an ejection fraction of less than 40%, experience myocardial infarction within 21 days before surgery, and have triple vessel or left main disease (P<0.05). Univariate analysis revealed no difference in in-hospital mortality between group A (2.2%) and group B (3.2%) (P=0.12); however, the composite outcome was more likely to occur in group B (40.8%) versus group A (27.9%) (P=0.0001). After multivariable adjustment, admission SG level of...

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Section: Discussionmentioning

confidence: 99%

Impact of admission serum glucose level on in-hospital outcomes following coronary artery bypass grafting surgery

Imran¹,

Ransom²,

Buth

et al. 2010

Canadian Journal of Cardiology

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“…34,[36][37][38] Many studies demonstrating admission blood glucose level as an independent outcome predictor were carried out in patients with acute vascular problems like stroke, myocardial infarction, and coronary artery bypass grafting. [39][40][41][42] Interestingly, ARDS, with diffuse pulmonary microvascular damage as the pathologic hallmark, is also a syndrome of acute vascular illness. A randomized controlled trial of early blood glucose control in at-risk subjects is ongoing and will further clarify to role of hyperglycemia (or insulin therapy) on ARDS (trial registration: clinicaltrials.gov; Identifi er: NCT00605696).…”

Section: Patients With Ards Excluded From Comparisonsmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Sepsis-Related vs Non-Sepsis-Related ARDS

Sheu

Gong

Zhai³

et al. 2010

Chest

202

146

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A RDS, the more severe form of acute lung injury (ALI), is a common and lethal disease in ICUs worldwide. Clinically, ARDS is characterized by acute respiratory failure with severe hypoxemia and diffuse pulmonary infi ltrates. Despite recent advances in critical care and signifi cant efforts invested in the basic research and clinical trials of ARDS, its mortality rate (35%-45%) has remained relatively unchanged since 1994. 1 ARDS usually develops in patients with predisposing conditions that induce systemic infl ammatory response, such as sepsis, pneumonia, major trauma, multiple transfusions, aspiration, and acute pancreatitis, among which sepsis is the most common cause of ARDS. [2][3][4][5] In a large prospective cohort study, severe sepsis with a suspected pulmonary source (46%) or a nonpulmonary source (33%) was the most common risk factor for ALI. 6 On the other hand, only Background: ARDS may occur after either septic or nonseptic injuries. Sepsis is the major cause of ARDS, but little is known about the differences between sepsis-related and non-sepsis-related ARDS. Methods: A total of 2,786 patients with ARDS-predisposing conditions were enrolled consecutively into a prospective cohort, of which 736 patients developed ARDS. We defi ned sepsis-related ARDS as ARDS developing in patients with sepsis and non-sepsis-related ARDS as ARDS developing after nonseptic injuries, such as trauma, aspiration, and multiple transfusions. Patients with both septic and nonseptic risks were excluded from analysis. Results: Compared with patients with non-sepsis-related ARDS (n 5 62), patients with sepsisrelated ARDS (n 5 524) were more likely to be women and to have diabetes, less likely to have preceding surgery, and had longer pre-ICU hospital stays and higher APACHE III (Acute Physiology and Chronic Health Evaluation III) scores (median, 78 vs 65, P , .0001). There were no differences in lung injury score, blood pH, Pa O 2 /F IO 2 ratio, and Pa CO 2 on ARDS diagnosis. However, patients with sepsis-related ARDS had signifi cantly lower Pa O 2 /F IO 2 ratios than patients with nonsepsis-related ARDS patients on ARDS day 3 ( P 5 .018), day 7 ( P 5 .004), and day 14 ( P 5 .004) (repeated-measures analysis, P 5 .011). Compared with patients with non-sepsis-related ARDS, those with sepsis-related had a higher 60-day mortality (38.2% vs 22.6%; P 5 .016), a lower successful extubation rate (53.6% vs 72.6%; P 5 .005), and fewer ICU-free days ( P 5 .0001) and ventilatorfree days ( P 5 .003). In multivariate analysis, age, APACHE III score, liver cirrhosis, metastatic cancer, admission serum bilirubin and glucose levels, and treatment with activated protein C were independently associated with 60-day ARDS mortality. After adjustment, sepsis-related ARDS was no longer associated with higher 60-day mortality (hazard ratio, 1.26; 95% CI, 0.71-2.22). Conclusion: Sepsis-related ARDS has a higher overall disease severity, poorer recovery from lung injury, lower successful extubation rate, and higher mortality than non-sepsis-related ...

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“…One of the immediate roles of hyperglycemia in hypovolemic shock, for example, is to act as an inert solute that increases plasma osmolality and draws fluid into the vascular compartment [16]. However, despite this positive effect, early hyperglycemia (over 200 mg/dl) is an indicator of infection and mortality independent of injury characteristics [17], and there is a positive correlation between plasma glucose levels and 30-day mortality in patients receiving coronary artery bypass grafting [18].…”

Section: Discussionmentioning

confidence: 97%