Glycemic variability and mortality in patients hospitalized in general surgery wards

Akirov, Amit; Shochat, Tzipora; Dotan, Idit; Diker-Cohen, Talia; Gorshtein, Alexander; Shimon, Ilan

doi:10.1016/j.surg.2019.02.022

Cited by 30 publications

(29 citation statements)

References 45 publications

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“…Compared with hyperglycemia, blood GV better reflects 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]. 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 [14].…”

Section: Introductionmentioning

confidence: 99%

Association between glucose variability and postoperative delirium in acute aortic dissection patients: an observational study

Lin

Peng

et al. 2021

J Cardiothorac Surg

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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 body mass index, history of cardiac surgery, 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 delirium group exhibited significantly higher values of the mean of blood glucose (MBG) and the standard deviation of blood glucose (SDBG) than in the non-delirium group(P < 0.05). In model 1, the adjusted hazard ratio (AHR) 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. The area under the curve of the SDBG 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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Section: Introductionmentioning

confidence: 99%

Association between glucose variability and postoperative delirium in acute aortic dissection patients: an observational study

Lin

Peng

et al. 2021

J Cardiothorac Surg

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“…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 . 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 14 .…”

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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“…Glycemic variability has been reported to be a strong independent risk factor for mortality in critically ill patients [28,29], and Nusca et al [30] have suggested that glycemic variability is a potential risk factor for the development of cardiac complications in both diabetic and non-diabetic patients. Furthermore, Akirov et al [31] have reported that in patients with or without diabetes mellitus who are hospitalized in general surgery wards, high glycemic variability is associated with longer hospitalization and higher short-term and long-term mortality. These findings imply that surgeons should be concerned about the degree of glycemic variability after gastrectomy, in addition to hypoglycemia, not only with regard to the short-term outcomes and QOL, but also with regard to the long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Utility of continuous glucose monitoring following gastrectomy

et al. 2020

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Background Glucose fluctuation after gastrectomy represented by dumping syndrome is a well-known post-gastrectomy syndrome that negatively impacts patient quality of life. However, the current methods of post-gastrectomy glucose monitoring do not comprehensively capture the postoperative blood glucose fluctuations that characterize this. Methods We used a continuous glucose monitoring (CGM) system to document the glycemic profiles of patients undergoing gastrectomy and compared these between patients undergoing distal gastrectomy (DG) and total gastrectomy (TG). To evaluate post-gastrectomy syndromes, including dumping syndrome, we used the Post-gastrectomy Syndrome Assessment Scale 37-item questionnaire. The glycemic profiles were also compared using this tool. Results We studied 57 patients who had undergone DG and 13 who had undergone TG between September 2017 and September 2019. Our results revealed larger diurnal glycemic variability and longer periods of nocturnal hypoglycemia after gastrectomy. The dumping score was worse in the TG than in the DG group (TG 2.4 ± 1.4 vs. DG 1.3 ± 1.2, P = 0.0061). Importantly, 30 of 57 DG patients (52.6%) and 5 of 13 TG patients (38.5%) experienced postprandial hypoglycemia following hyperglycemia without hypoglycemic symptoms. There was no correlation between the dumping symptom score and glycemic variability (ρ = 0.0545, P = 0.6662). Conclusions CGM demonstrated diurnal glycemic variability and nocturnal hypoglycemia in patients undergoing gastrectomy. Because some hypoglycemic patients did not develop symptoms and glycemic variability was not necessarily associated with dumping symptom, dumping syndrome must only partially explain the postoperative glucose fluctuations.

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Glycemic variability and mortality in patients hospitalized in general surgery wards

Cited by 30 publications

References 45 publications

Association between glucose variability and postoperative delirium in acute aortic dissection patients: an observational study

Association between glucose variability and postoperative delirium in acute aortic dissection patients: an observational study

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

Utility of continuous glucose monitoring following gastrectomy

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