High blood glucose variability is associated with bacteremia and mortality in patients hospitalized with acute infection

Atamna, Alaa; Ayada, Gida; Akirov, Amit; Shochat, Tzippy; Bishara, Jihad; Elis, Avishay

doi:10.1093/qjmed/hcy235

Cited by 20 publications

(17 citation statements)

References 27 publications

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“…blood glucose data in the Netherlands found that the SD and mean amplitude of glycemic excursions of glucose levels were significantly associated with the hospital mortality rate (23). Additionally, Atamna et al (24) found that a high CV was significantly associated with the 30-day and 5-year mortality of patients hospitalized with acute infectious diseases. Moreover, the Netherlands study reported that glycemic fluctuations can be related to the severity of influenza, as indicated by damage of the alveolar epithelial-endothelial barrier in the mouse model of influenza A virus infection, thus promoting apoptosis (23).…”

Section: Discussionmentioning

confidence: 99%

Thresholds of Glycemia and the Outcomes of COVID-19 Complicated With Diabetes: A Retrospective Exploratory Study Using Continuous Glucose Monitoring

et al. 2021

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Although elevated glucose levels are reported to be associated with adverse outcomes of coronavirus disease 2019 (COVID-19), the optimal range of glucose in patients with COVID-19 and diabetes remains unknown. This study aimed to investigate the threshold of glycemia and its association with the outcomes of COVID-19. RESEARCH DESIGN AND METHODS Glucose levels were assessed through intermittently scanned continuous glucose monitoring in 35 patients for an average period of 10.2 days. The percentages of time above range (TAR), time below range (TBR), time in range (TIR), and coefficient of variation (CV) were calculated. Composite adverse outcomes were defined as either the need for admission to the intensive care unit, need for mechanical ventilation, or morbidity with critical illness. RESULTS TAR using the threshold of 160-200 mg/dL was significantly associated with composite adverse outcomes after adjustment of covariates. Both TBR (<70 mg/dL) and TIR (70-160 mg/dL), but not mean sensor glucose level, were significantly associated with composite adverse outcomes and prolonged hospitalization. The multivariate-adjusted odds ratios of the CV of sensor glucose across tertiles for composite adverse outcomes of COVID-19 were 1.00, 1.18, and 25.2, respectively. CONCLUSIONS Patients with diabetes and COVID-19 have an increased risk of adverse outcomes with glucose levels >160 mg/dL and <70 mg/dL and a high CV. Therapies that improve these metrics of glycemic control may result in better prognoses for these patients. Epidemiological studies have reported that approximately one-half of patients with coronavirus disease 2019 (COVID-19) have comorbidities, of which diabetes is the second most common (1,2). There was more than a fourfold chance of patients with diabetes and COVID-19 meeting the primary composite end point of need for intensive

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Section: Discussionmentioning

confidence: 99%

Thresholds of Glycemia and the Outcomes of COVID-19 Complicated With Diabetes: A Retrospective Exploratory Study Using Continuous Glucose Monitoring

et al. 2021

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“…The relationship between glycemic variability and infection risk has been evaluated in previous studies 31,35 . Atamna et al studied 1,485 patients with respiratory, urinary tract, and soft-tissue infections and found that higher glucose variability increased the risk of bacteremia and mortality 35 , and Donati et al reported that patients in the intensive care unit who had higher glucose variability were more likely to contract hospital-acquired infections 31 . In the context of joint arthroplasty, PJI represents a disastrous complication that dramatically increases the mortality risk and diminishes the quality of life of patients undergoing orthopaedic procedures [43][44][45] .…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, perioperative hyperglycemia has been identified as a risk factor for poor outcomes in hospitalized patients. Glucose variability is one such metric that has been studied extensively 2,10-12,31-35 . Mendez et al reported that higher glucose variability during hospitalization was associated with longer length of stay and higher mortality rates in 935 non-critically ill patients, regardless of the mean glucose level, although only 171 were surgical candidates in that cohort 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Another important finding of this study was that patients who underwent revision TJA and had high glucose variability were at twice the risk of PJI. The relationship between glycemic variability and infection risk has been evaluated in previous studies 31,35 . Atamna et al studied 1,485 patients with respiratory, urinary tract, and soft-tissue infections and found that higher glucose variability increased the risk of bacteremia and mortality 35 , and Donati et al reported that patients in the intensive care unit who had higher glucose variability were more likely to contract hospital-acquired infections 31 .…”

Section: Discussionmentioning

confidence: 99%

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Serum Glucose Variability Increases the Risk of Complications Following Aseptic Revision Hip and Knee Arthroplasty

Goh

Shohat

Abdelaal

et al. 2022

Journal of Bone and Joint Surgery

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Background:Increased serum glucose variability has been proposed as a risk factor for perioperative morbidity and mortality. Given the greater surgical complexity and complication risk of revision total joint arthroplasty (TJA), previous findings may not be generalizable to the revision population. The purpose of this study was to investigate the association between glucose variability and postoperative complications following aseptic revision TJA.Methods:We identified 1,983 patients who underwent an aseptic revision TJA (636 total knee arthroplasties [TKAs] and 1,347 total hip arthroplasties [THAs]) from 2001 to 2019. Patients with ≥2 postoperative glucose values per day or ≥3 values during hospitalization were included in this study. Glucose variability was assessed using the coefficient of variation (COV). Outcomes included length of hospital stay, 90-day complications, mortality, and periprosthetic joint infection (PJI) as defined by the 2018 International Consensus Meeting criteria. Multivariate regression was used to determine the association between glucose variability and each end point, using COV as continuous and categorical variables (that is, COV tertiles).Results:Patients with high glycemic variability were at 1.7 times greater risk for 90-day complications (odds ratio [OR], 1.664 [95% confidence interval (CI), 1.266 to 2.188]; p < 0.001) and 2 times greater risk for PJI at a minimum 1-year follow-up (OR, 1.984 [95% CI, 1.270 to 3.100]; p = 0.003). The risk of 90-day complications increased by 2.2% (OR, 1.022 [95% CI, 1.012 to 1.032]; p < 0.001) and the risk of PJI increased by 1.8% (OR, 1.018 [95% CI, 1.003 to 1.034]; p = 0.013) for every percentage-point increase in COV. Patients with higher glucose variability also had a longer length of stay (beta, 1.028 days [95% CI, 0.590 to 1.466 days]; p < 0.001). These associations were independent of age, sex, body mass index, Charlson Comorbidity Index, involved joint, operative time, history of diabetes, and mean glucose levels.Conclusions:Higher glucose variability was associated with an increased risk of medical complications and PJI following aseptic revision TJA. Patients undergoing these complex procedures should have glucose levels monitored closely in the perioperative period. Future studies should evaluate the utility of continuous glucose monitoring in this high-risk population.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…• Se recomienda evitar el consumo de carbohidratos y azúcares refinados, debido a que se han relacionado con disminución en la capacidad de respuesta de los leucocitos, tanto en estudios de laboratorio como en estudios in vivo, aumentando así el riesgo de desarrollar infecciones (11,12) .…”

Section: Decisiones Alimentariasunclassified

Pandemia COVID-19: ¿Qué más puedo hacer?

G.¹

2020

RFMH

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High blood glucose variability is associated with bacteremia and mortality in patients hospitalized with acute infection

Cited by 20 publications

References 27 publications

Thresholds of Glycemia and the Outcomes of COVID-19 Complicated With Diabetes: A Retrospective Exploratory Study Using Continuous Glucose Monitoring

Thresholds of Glycemia and the Outcomes of COVID-19 Complicated With Diabetes: A Retrospective Exploratory Study Using Continuous Glucose Monitoring

Serum Glucose Variability Increases the Risk of Complications Following Aseptic Revision Hip and Knee Arthroplasty

Pandemia COVID-19: ¿Qué más puedo hacer?

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