The impact of the blood glucose levels of non-diabetic critically ill patients on their clinical outcome

Koyfman, Leonid; Brotfain, Evgeni; Erblat, Alexander; Kovalenko, Inna; Reina, Yair-Yaish; Bichovsky, Yoav; Borer, Abraham; Friger, Michael; Frenkel, Amit; Klein, Moti

doi:10.5603/ait.2018.0004

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…Cytokine release as a consequence of severe infection may precipitate the onset of metabolic alterations by affecting glucose homeostasis, which lead to abnormalities in glycometabolic control, insulin resistance and beta cell dysfunction in patients with infection without any pre-existing history or diagnosis of diabetes. Stress hyperglycaemia seriously affects the stability of the body's internal environment, which cause a profound impact on metabolism and immune function, thereby affecting the patients' prognosis [4,5]. Stress hyperglycaemia is associated with an increased risk of in-hospital mortality regardless of whether the patients have diabetes background or not [1,6].…”

Section: / 25mentioning

confidence: 99%

Profiling of circulating serum exosomal microRNAs in elderly patients with infectious stress hyperglycaemia

Zeng

He²,

Lv³

et al. 2023

Preprint

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Early diagnosis of hospitalized elderly patients with infectious stress hyperglycaemia (ISH) is clinically important, as without timely prevention and effective treatment, it is likely to deteriorate into septic shock, which significantly worsen patients’ survival rate. Systematic screening of specific biomarkers of serum small extracellular vesicles (sEVs) from ISH patient has not yet been reported. In this study, serum sEVs were derived from 10 elderly patients with ISH and 5 control patients with disease-match without hyperlycemia (non-ISH). RNA sequencing identified a total number of 49 sEVs enriched fraction derived miRNAs with differential expression between ISH and control group. Of which, top 22 miRNAs ranked by sensitivity × specificity were chosen for further research. Moreover,7 out of 22 miRNAs that related to glucose metabolism or immune disorder, were picked up for further validation in an independent cohort consisting of 52 participants (31 ISH and 21 non-ISH). A validation analysis revealed that 3 miRNAs (hsa-miR-21-5p，hsa-miR-335-5p，hsa-miR-28-3p) were statistically up-regulated in exosomes from ISH patients. In the validation cohort and discovery cohort, the AUC of 3 individual miRNAs ranged from 0.73 to 0.88. A logistic model combining three miRNAs achieved an AUC of 0.96. Besides,sEV‐miRNA‐based signatures effectively characterized patients’ poor clinical outcome. Survival curve analysis showed that miR-335-5p, miR-28-3p but not miR-21-5p, were significantly closely related to mortality, and the combination of the three could also predict patients outcome.(P<0.05).This study depicted the circulating exosomal miRNAs change in ISH patient and which could be used as a promising biomarker to detect ISH at an early stage, and predict patients clinical outcome.

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Section: / 25mentioning

confidence: 99%

Profiling of circulating serum exosomal microRNAs in elderly patients with infectious stress hyperglycaemia

Zeng

He²,

Lv³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Stress hyperglycaemia seriously affects the stability of the body's internal environment, which cause a profound impact on metabolism and immune function, thereby affecting the patients' prognosis. 2,8 Stress hyperglycaemia is associated with an increased risk of in-hospital mortality regardless of whether the patients have diabetes background or not. 1,9 It is suggested that COVID-19-associated newonset hyperglycaemia may predispose patients to longterm hyperglycaemia, worse clinical outcomes and clinical scores, prolonged hospital stays higher demand for oxygen support or positive-pressure ventilation.…”

Section: Introductionmentioning

confidence: 99%

“…Cytokine release as a consequence of severe infection may precipitate the onset of metabolic alterations by affecting glucose homeostasis, which leads to abnormalities in glycometabolic control, insulin resistance (IR) and β cell dysfunction in patients with infection even without any pre‐existing history or diagnosis of diabetes. Stress hyperglycaemia seriously affects the stability of the body's internal environment, which cause a profound impact on metabolism and immune function, thereby affecting the patients’ prognosis 2,8 . Stress hyperglycaemia is associated with an increased risk of in‐hospital mortality regardless of whether the patients have diabetes background or not 1,9 .…”

Section: Introductionmentioning

confidence: 99%

Profiling of circulating serum exosomal microRNAs in elderly patients with infectious stress hyperglycaemia

Zeng

Lv³

et al. 2023

Clinical and Translational Dis

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BackgroundEarly diagnosis of hospitalized elderly patients with infectious stress hyperglycaemia (ISH) is clinically important, especially under the global coronavirus disease 2019 (COVID‐19) pandemic, as without timely prevention and effective treatment, it is likely to deteriorate into septic shock, thus worsening patient survival and complications. Moreover, cumulative studies have showed that patients with COVID‐19 are reported to have a greater prevalence of hyperglycaemia. However, the underlying mechanism remained unknown.Aim and methodSystematic screening of specific biomarkers of serum exosome‐derived microRNAs (sE‐miRNAs) from ISH patient has not yet been reported. In this study, sE‐miRNAs were derived from 10 elderly patients with ISH and 5 control patients with disease‐match without hyperglycaemia (non‐ISH). RNA sequencing identified that a total number of 49 sE‐miRNAs with differential expression between ISH and control group. Of which, top 22 miRNAs ranked by sensitivity × specificity were chosen for further research. Moreover, 7 out of 22 miRNAs that related to glucose metabolism or immune disorder were picked up for further validation in an independent cohort consisting of 52 participants (31 ISH and 21 non‐ISH).ResultA validation analysis revealed that three miRNAs (hsa‐miR‐21‐5p, hsa‐miR‐335‐5p and hsa‐miR‐28‐3p) were statistically up‐regulated in exosomes from ISH patients. In the validation cohort and discovery cohort, the AUC of three individual miRNAs ranged from 0.73 to 0.88. A logistic model combining three miRNAs achieved an AUC of 0.96. Besides, sE‐miRNAs‐based signatures effectively characterized patients' poor clinical outcome. Survival curve analysis showed that hsa‐miR‐335‐5p, hsa‐miR‐28‐3p but not hsa‐miR‐21‐5p, were significantly closely related to mortality, and the combination of these three miRNAs could also predict patients outcome (p < .05).ConclusionThis study depicted the circulating exosomal miRNAs change in ISH patient, which could be used as a promising biomarker to detect ISH at an early stage and predict patients clinical outcome.

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“…Insulin resistance may lead to hyperglycemia and decreased tissue responsiveness to the biological activity of insulin, a metabolic problem that induces catabolic state and may lead to increased morbidity, prolonged hospital and intensive care unit (ICU) stay and decreased survival [ 2 , 3 , 4 , 5 ]. Stress hyperglycemia, even in non-diabetic patients, is a marker of stress response in critically ill patients and results from a release of contra-insulin hormones (i.e., glucocorticoids and catecholamines) [ 6 ]. Hyperglycemia after cardiac surgery can be detrimental to the heart due to glucose toxicity that causes increased oxidative stress via the hexosamine metabolic pathway and by elevated levels of advanced glycation end-products [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

et al. 2020

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Background and aim: Preoperative fasting leads to metabolic stress and causes insulin resistance in patients undergoing cardiac surgery. The aim of this study was to assess the effect of preoperative oral carbohydrate loading (OCH) on outcome in patients undergoing planned cardiac surgery by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods: Systematic search of PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was performed to identify relevant RCTs from databased inception until 05/03/2020. We included studies that compared outcome measures between OCH with control (placebo or standard starvation). We conducted a random-effect meta-analysis of clinical and biochemical parameters. Results: Nine studies (N = 9) were included with a total of 507 patients. OCH significantly decreased aortic clamping duration (n = 151, standardized mean difference (SMD) = −0.28, 95% confidence interval (CI) = −0.521 to −0.038, p = 0.023 and differences in means (DM) = −6.388, 95%CI = −11.246 to −1.529, p = 0.010). Patients from treatment groups had shorter intensive care unit (ICU) stay (n = 202, SMD = −0.542, 95%CI = −0.789 to −0.295, p < 0.001 and DM = −25.925, 95%CI = −44.568 to −7.283, p = 0.006) and required fewer units of insulin postoperatively (n = 85, SMD = −0.349, 95%CI = −0.653 to −0.044, p = 0.025 and DM = −4.523, 95%CI = −8.417 to −0.630, p = 0.023). The necessity to use inotropic drugs was significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI = 0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a significant effect. Conclusions: Preoperative OCH in patients undergoing cardiac surgery demonstrated a 20% reduction in the use of inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease in aortic clamping duration and a 35% decrease of postoperative insulin requirement.

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The impact of the blood glucose levels of non-diabetic critically ill patients on their clinical outcome

Cited by 7 publications

References 9 publications

Profiling of circulating serum exosomal microRNAs in elderly patients with infectious stress hyperglycaemia

Profiling of circulating serum exosomal microRNAs in elderly patients with infectious stress hyperglycaemia

Profiling of circulating serum exosomal microRNAs in elderly patients with infectious stress hyperglycaemia

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

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