Effects of Hyperglycemia and Continuous Intravenous Insulin on Outcomes of Surgical Patients

Schlussel, Andrew T.; Holt, Danielle B.; Crawley, Eric A.; Lustik, Michael B.; Wade, Charles E.; Uyehara, Catherine F. T.

doi:10.1016/j.jss.2011.07.004

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…After title and abstract screening, 385 records were kept for full-text retrieval and 43 articles were included at full-text review (Fig 1). The results presented here are for 42 studies (536,476 patients), as two articles [30,31] were linked and reported data from the same study.…”

Section: Resultsmentioning

confidence: 99%

A systematic scoping review on the consequences of stress-related hyperglycaemia

Olariu¹,

Pooley²,

Danel

et al. 2018

PLoS ONE

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BackgroundStress-related hyperglycaemia (SHG) is commonly seen in acutely ill patients and has been associated with poor outcomes in many studies performed in different acute care settings. We aimed to review the available evidence describing the associations between SHG and different outcomes in acutely ill patients admitted to an ICU. Study designs, populations, and outcome measures used in observational studies were analysed.MethodsWe conducted a systematic scoping review of observational studies following the Joanna Briggs methodology. Medline, Embase, and the Cochrane Library were searched for publications between January 2000 and December 2015 that reported on SHG and mortality, infection rate, length of stay, time on ventilation, blood transfusions, renal replacement therapy, or acquired weakness.ResultsThe search yielded 3,063 articles, of which 43 articles were included (totalling 536,476 patients). Overall, the identified studies were heterogeneous in study conduct, SHG definition, blood glucose measurements and monitoring, treatment protocol, and outcome reporting. The most frequently reported outcomes were mortality (38 studies), ICU and hospital length of stay (23 and 18 studies, respectively), and duration of mechanical ventilation (13 studies). The majority of these studies (40 studies) compared the reported outcomes in patients who experienced SHG with those who did not. Fourteen studies (35.9%) identified an association between hyperglycaemia and increased mortality (odds ratios ranging from 1.13 to 2.76). Five studies identified hyperglycaemia as an independent risk factor for increased infection rates, and one identified it as an independent predictor of increased ICU length of stay.DiscussionSHG was consistently associated with poor outcomes. However, the wide divergences in the literature mandate standardisation of measuring and monitoring SHG and the creation of a consensus on SHG definition. A better comparability between practices will improve our knowledge on SHG consequences and management.

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Section: Resultsmentioning

confidence: 99%

A systematic scoping review on the consequences of stress-related hyperglycaemia

Olariu¹,

Pooley²,

Danel

et al. 2018

PLoS ONE

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“…Plenty of observational studies have demonstrated that the glucose level during ICU admission was related to mortality by a U-shaped curve [11, 12]. Both hyperglycemia and hypoglycemia had an increased risk of death and were associated with an increase in the ICU length of stay [13–16]. The “safe range” of glucose has been defined between 7.0 and 9.0 mmol/L which is within the optimal blood glucose concentration (BGC) target range (NICE-SUGAR protocol) [12, 13].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Serum Glucose on the Predictive Value of Serum Lactate for Hospital Mortality in Critically Ill Surgical Patients

Chen

Zhang

et al. 2019

Disease Markers

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Background Lactate has been widely used as a risk indicator of outcomes in critically ill patients due to its ready measurement and good predictive ability. However, the interconnections between lactate metabolism and glucose metabolism have not been sufficiently explored, yet. In this study, we aimed to investigate whether glucose levels could influence the predictive ability of lactate and design a more comprehensive strategy to assess the in-hospital mortality of critically ill patients. Methods We analyzed the clinical data of 293 critically ill patients. The primary outcome was in-hospital mortality. The logistic regression analysis and the area under the receiver operating characteristic curve (AUROC) were applied to evaluate the predictive ability of lactate in association with glucose. Results The lactate level showed significant association with in-hospital mortality, and its predictive ability was also comparable to other prognostic scores such as the SOFA score and APACHE II score. We further divided 293 patients into three groups based on glucose levels: low-glucose group (<7 mmol/L), medium-glucose group (7-9 mmol/L), and high-glucose group (>9 mmol/L). The lactate level was associated with in-hospital mortality in the low- and high- glucose groups, but not in the medium-glucose group, whereas the SOFA score and APACHE II score were associated with in-hospital mortality in all three glucose groups. The AUROC of lactate in the medium-glucose group was also the lowest among the three glucose groups, indicating a decrease in its predictive ability. Conclusions Our findings demonstrated that the predictive ability of lactate to assess in-hospital mortality could be influenced by glucose levels. In the medium glucose level (i.e., 7-9 mmol/L), lactate was inadequate to predict in-hospital mortality and the SOFA score; the APACHE II score should be utilized as a complementation in order to obtain a more accurate prediction.

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“…In terms of the hyperglycemic threshold, the blood glucose level beyond which clinical complications occur seems to differ by casemix (Table 2 ). Patients without diabetes mellitus (DM)[ 26 ], patients with traumatic brain injury (TBI), and post-surgical patients at risk of wound infection experience adverse effects of hyperglycemia at a relatively low range, with the threshold set at 6.7-8.3 mmol/L[ 27 - 30 ].…”

Section: Empirical Evidence For Glycemic Thresholds In Icumentioning

confidence: 99%

Glycemic targets in critically ill adults: A mini-review

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2021

WJD

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Illness-induced hyperglycemia impairs neutrophil function, increases pro-inflammatory cytokines, inhibits fibrinolysis, and promotes cellular damage. In turn, these mechanisms lead to pneumonia and surgical site infections, prolonged mechanical ventilation, prolonged hospitalization, and increased mortality. For optimal glucose control, blood glucose measurements need to be done accurately, frequently, and promptly. When choosing glycemic targets, one should keep the glycemic variability < 4 mmol/L and avoid targeting a lower limit of blood glucose < 4.4 mmol/L. The upper limit of blood glucose should be set according to casemix and the quality of glucose control. A lower glycemic target range ( i.e. , blood glucose 4.5-7.8 mmol/L) would be favored for patients without diabetes mellitus, with traumatic brain injury, or who are at risk of surgical site infection. To avoid harm from hypoglycemia, strict adherence to glycemic control protocols and timely glucose measurements are required. In contrast, a higher glycemic target range ( i.e. , blood glucose 7.8-10 mmol/L) would be favored as a default choice for medical-surgical patients and patients with diabetes mellitus. These targets may be modified if technical advances for blood glucose measurement and control can be achieved.

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Effects of Hyperglycemia and Continuous Intravenous Insulin on Outcomes of Surgical Patients

Cited by 9 publications

References 31 publications

A systematic scoping review on the consequences of stress-related hyperglycaemia

A systematic scoping review on the consequences of stress-related hyperglycaemia

The Impact of Serum Glucose on the Predictive Value of Serum Lactate for Hospital Mortality in Critically Ill Surgical Patients

Glycemic targets in critically ill adults: A mini-review

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