Association of Blood Glucose Variability with Sepsis-Related Disseminated Intravascular Coagulation Morbidity and Mortality

Abstract

Purpose Sepsis-related disseminated intravascular coagulation (DIC) is closely associated with poor prognosis and high mortality. Higher blood glucose (BG) variability indicates an increased risk of mortality in sepsis; however, its relationship with sepsis-related DIC has not been investigated. This study aimed to determine the association between glucose variability and sepsis-related DIC. Patients and Methods Patients with sepsis admitted to the intensive care unit were enrolled between October 2017 and January 2021. Baseline data and BG records from the first 72 h were collected. We calculated the glucose liability index (GLI), largest amplitude of glucose excursion, BG standard deviation, and coefficient of variation on days 1 and 3. The relationship between GLI and morbidity of sepsis-related DIC was explored using a competing risk model. In subgroup analysis, we divided patients with and without diabetes into three groups according to the BG range. Results Of the 238 patients enrolled, 28.2% developed DIC during hospitalization (n=67). GLI on day 3 was found to have the closest relationship with DIC incidence as it has the largest area under the ROC curve and the highest associated odds ratio of death per unit change (GLI3-day: AUC=0.891 OR=1.84), also independently increased the occurrence of DIC after adjusting for the competing risk of death (sub-distribution hazard ratios=1.866, p<0.01). In subgroup analysis, patients with diabetes had worse outcomes under hypoglycemia than under hyperglycemia. Patients without diabetes having stable BG had the best outcomes. Conclusion Our study suggested that a higher GLI in patients with sepsis at 72 h was independently associated with an increased risk of sepsis-related DIC, which was not associated with pre-existing diabetes.

High blood glucose variability may predict poor outcomes in patients with spontaneous cerebellar hemorrhage undergoing surgical operation: a retrospective study

“…Although sustained hyperglycemia promotes the expression of markers of oxidative stress, a fluctuating rise in BG corresponds to a more severe oxidative stress response [ 13 , 41 ]. Oxidative stress and inflammatory responses lead to impairment of endothelial function by increasing apoptosis of vascular endothelial cells [ 20 , 30 ]. And fibroblasts produced increased cytokines in cells with fluctuating glucose levels [ 42 ], which may increase the inflammatory response.…”

Association of blood glucose change with postoperative delirium after coronary artery bypass grafting in patients with diabetes mellitus: a study of the MIMIC-IV database

“…MAG was divided into ≤0.77 mmol/L/h and >0.77 mmol/L/h, and MAGE was divided into ≤2.58 mmol/L and >2.58 mmol/L according to their median value, respectively. The GLI as the squared difference between consecutive glucose measurements per unit of actual time (Δh) between those records was calculated as follows: GLI = Σ [{Δglucose (mmol/L)} 2 ·Δh −1] (per se) ( 18 ). GLI was stratified into ≤2.6 (mmol/L) 2 /h/per se and >2.6 (mmol/L) 2 /h/per se according to the median value.…”