Glycaemic variability and its association with enteral and parenteral nutrition in critically ill ventilated patients

Doola, Ra’eesa; Greer, Ristan M.; Hurford, Rod; Flatley, Christopher; Forbes, Josephine M.; Todd, Alwyn; Joyce, Chris; Sturgess, David

doi:10.1016/j.clnu.2018.08.001

Cited by 19 publications

(23 citation statements)

References 38 publications

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“…However, multivariate logistic regression analysis revealed that GV is independently associated with ICU mortality, even after controlling for MGL and disease severity. These findings are consistent with those of recent retrospective studies that have shown that GV is a predictor of mortality among adult and pediatric ICU patients (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Put together, these findings indicate that GV indices can be used for the prognostic assessment of critically ill ICU patients.…”

Section: Discussionsupporting

confidence: 92%

“…Studies have shown an independent relationship between GV and mortality in heterogeneous populations of critically ill patients (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), a population group in which GV has a stronger association with mortality than hyperglycemia and hypoglycemia (8). Generally, accepted guidelines also recommend that GV be reported in studies that investigate the management of blood glucose (BG) levels (20).…”

Section: Introductionmentioning

confidence: 99%

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Glycemic Variability: An Independent Predictor of Mortality and the Impact of Age in Pediatric Intensive Care Unit

Liu

et al. 2020

Front. Pediatr.

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Objective: To compare the ability of different indices of glycemic variability (GV) in the prognostic evaluation of critically ill children and investigate whether heterogeneity of glucose control exists within this population group. Methods: We conducted a retrospective study of the GV data collected from patients admitted to the pediatric intensive care unit, Children's Hospital of Chongqing Medical University between January 2016 and December 2016. We calculated the mean glucose level (MGL) and four indices of GV, namely, standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), and glycemic lability index (GLI). The 28-day mortality was considered as the primary endpoint. Results: Survivors and non-survivors showed significant differences in terms of the SD, CV, MAGE, and GLI ( P < 0.05, for all). However, GLI was superior to the other indices and showed an independent association with ICU mortality (odds ratio [OR], 1.082; 95% confidence interval [CI], 1.031–1.135; P < 0.01). Sub-group analysis disaggregated by quartiles of MGL and GV revealed that younger subjects (age ≤ 36 months) had significantly higher mortality in the lowest quartile of the MGL and in the highest quartile of GV; the older children (age > 36 months) experienced significantly higher mortality in the highest quartiles of MGL and GV. Conclusion: GV is closely associated with mortality, and among all glucose parameters evaluated, GLI was found to be the strongest predictor of outcomes. This paper is the first report of age being a potentially important modifier of the association between GV, MGL, and mortality in critically ill children.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Glycemic Variability: An Independent Predictor of Mortality and the Impact of Age in Pediatric Intensive Care Unit

Liu

et al. 2020

Front. Pediatr.

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“…In recent years, more attention has been paid to the study of blood glucose variability (GV) on disease progression and prognosis of patients, and it has important clinical signi cance for monitoring and controlling of blood GV in severe patients 9,10 . Compared with hyperglycemia, blood GV better re ects changes in the condition and has greater adverse effects on the body, which may have higher clinical value 10,11 . It is well known that blood GV increases the risk of adverse events after cardiac surgery, such as acute kidney injury, and the risk of short-term and long-term death 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Association Between Glucose Variability And Postoperative Delirium In Acute Aortic Dissection Patients: An Observational Study

Lin

Peng

et al. 2020

Preprint

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Background: Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients.Methods: We prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess.Results: A total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in age, body mass index, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay (P<0.05). The median of the mean of blood glucose and the standard deviation of blood glucose were higher in the delirium group than in the non-delirium group, and the difference was statistically significant (P<0.05). In model 1, the adjusted hazard ratio of the standard deviation of blood glucose was 1.436 (P<0.05). In Model 2, the standard deviation of blood glucose (AHR=1.418, 95% CI=1.195-1.681, P<0.05) remained significant after adjusting for confounders (P<0.05). The area under the curve of the standard deviation of blood glucose was 0.763 (95% CI=0.704-0.821, P<0.01). The sensitivity was 81.6%, and the specificity was 57.8%. Conclusions: Glucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.

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“…8 In recent years, more attention has been paid to the study of blood glucose variability (GV) on disease progression and prognosis of patients, and it has important clinical significance for monitoring and controlling of blood GV in severe patients. 9,10 Compared with hyperglycemia, blood GV can better reflect changes in the condition and has greater adverse effects on the body, which may has higher clinical value. 10,11 It is well known that blood GV increases the risk of adverse events after cardiac surgery, such as acute kidney injury, and the risk of short-term and long-term death.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Compared with hyperglycemia, blood GV can better reflect changes in the condition and has greater adverse effects on the body, which may has higher clinical value. 10,11 It is well known that blood GV increases the risk of adverse events after cardiac surgery, such as acute kidney injury, and the risk of short-term and long-term death. 12,13 At present, only one article has pointed out that hypoglycemia is positively correlated with delirium in mixed ICU diabetic patients, but high blood GV is not correlated with delirium.…”

Section: Introductionmentioning

confidence: 99%

Association of glucose variability with postoperative delirium in acute aortic dissection patients: an observational study

Lin

Peng

et al. 2020

Preprint

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Background Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The aim of this study is to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients. Methods We prospectively analyzed 257 patients including 103 patients with delirium. The patients was categorized into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of Intensive Care Unit stay and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess. Results A total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in age, body mass index, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration and the length of Intensive Care Unit stay (P < 0.05). The median of mean of blood glucose and standard deviation of blood glucose were higher in the delirium group than in the non-delirium group, and the difference was statistically significant (P < 0.05). In model 1, the adjusted hazard ratio of standard deviation of blood glucose was 1.436 (P < 0.05). In Model 2, the SDBG (AHR = 1.418, 95% CI = 1.195–1.681, P < 0.05) remained significant after adjusting for confounders (P < 0.05). The area under curve of the SDBG ROC was 0.763 (95% CI = 0.704–0.821, P < 0.01). The sensitivity was 81.6%, and the specificity was 57.8%. Conclusions Glucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.

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Glycaemic variability and its association with enteral and parenteral nutrition in critically ill ventilated patients

Cited by 19 publications

References 38 publications

Glycemic Variability: An Independent Predictor of Mortality and the Impact of Age in Pediatric Intensive Care Unit

Glycemic Variability: An Independent Predictor of Mortality and the Impact of Age in Pediatric Intensive Care Unit

Association Between Glucose Variability And Postoperative Delirium In Acute Aortic Dissection Patients: An Observational Study

Association of glucose variability with postoperative delirium in acute aortic dissection patients: an observational study

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