Association Between Hyperglycemia and Increased Hospital Mortality in a Heterogeneous Population of Critically Ill Patients

Krinsley, James S.

doi:10.4065/78.12.1471

Cited by 1,032 publications

(661 citation statements)

References 15 publications

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“…A target between 6.0 and 7.0 mmol/L for median blood glucose also allows for variation and patient evolution, while providing a buffer against hypoglycemia. In particular, studies of glycemia and mortality show increasing risk of death average for glycemia of 7.0 mmol/L or greater, but no change in risk of death below 6.0 mmol/L [2,6,75]. In addition, a recent study of organ failure and SPRINT showed that cumulative time in the 4.4-7.0 mmol/L band greater than 50% was associated with faster reduction of organ failure [36].…”

Section: Discussionmentioning

confidence: 99%

“…It is strongly associated with increased mortality [6][7][8][9][10]. Hyperglycemia is also associated with increases in other negative clinical outcomes, including infection [11], sepsis and septic shock [10,12,13], myocardial infarction [2], and polyneuropathy and multi-organ failure [3,14].…”

Section: The Physiological and Clinical Problemmentioning

confidence: 99%

“…• Mortality increases with mean, maximum, and minimum and/or range of blood glucose in a range of cohorts [6][7][8][56][57][58][59].…”

Section: The Interrelationship Of Glycemia Tgc Patients and Outcomementioning

confidence: 99%

“…More specifically, the more critically ill the patient is, the more variable and greater their glycemia (e.g. [2,6,7,60,63,66,79,80]). However, glycemia merely reflects three main factors:…”

Section: Insulin Sensitivity Patient Variability and Impact On Tgcmentioning

confidence: 99%

See 3 more Smart Citations

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

123

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Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts.This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols.A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000 hours of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S I ). Variation in S I provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra-and inter-patient variability in insulin resistance (1/ S I ) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

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Section: Discussionmentioning

confidence: 99%

Section: The Physiological and Clinical Problemmentioning

confidence: 99%

“…• Mortality increases with mean, maximum, and minimum and/or range of blood glucose in a range of cohorts [6][7][8][56][57][58][59].…”

Section: The Interrelationship Of Glycemia Tgc Patients and Outcomementioning

confidence: 99%

Section: Insulin Sensitivity Patient Variability and Impact On Tgcmentioning

confidence: 99%

See 2 more Smart Citations

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

123

View full text Add to dashboard Cite

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“…In non‐diabetic patients undergoing major abdominal procedures, blood glucose (BG) values > 7 mmol/l are frequently observed. Evidence is mounting that hyperglycaemia is a predictor of mortality and complications, and that even a moderate increase in blood glucose may be associated with a worse outcome 22, 23, 24. Patients with fasting blood glucose concentrations > 7 mmol/l or random blood glucose concentrations > 11.1 mmol/l on general surgical wards showed a 18‐fold increased in‐hospital mortality, a longer hospital stay and a greater risk of infection 25.…”

Section: Metabolic Homoeostasismentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

346

198

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BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

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Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada

Kumar

Zarychanski

Pinto³

et al. 2009

JAMA

1,244

122

1,124

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Association Between Hyperglycemia and Increased Hospital Mortality in a Heterogeneous Population of Critically Ill Patients

Cited by 1,032 publications

References 15 publications

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada

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