The paradox of the glycemic gap: Does relative hypoglycemia exist in critically ill patients?

Guo, Jiun‐Yu; Chou, Ruey‐Hsing; Kuo, Cheng–Deng; Chao, Tze Fan; Wu, Chung Hsin; Tsai, Yi Lin; Lu, Ya Wen; Kuo, Ming Ren; Huang, Po Hsun; Lin, Shing Jong

doi:10.1016/j.clnu.2021.06.004

Cited by 14 publications

(19 citation statements)

References 32 publications

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“…Associations of SHR with adverse clinical outcomes in diabetic patients with pneumonia were explored by logistic regressions, in which potential confounding factors with complete available data were taken into consideration. SHR was proven to be independently associated with adverse clinical outcomes in patients with different severity on admission in our analyses (as shown in Figures 2 and 3), in line with previous studies on pneumonia or other acute diseases 13–21 . The strong association of excessive stress hyperglycemia and adverse clinical outcomes was quite obvious in our study and previous ones.…”

Section: Discussionsupporting

confidence: 92%

“…Recently, several studies highlighted the value of stress hyperglycemia, which presents the absolute glycemia change, in the analyses of prognoses in acute physiological events including pneumonia 13–21 . In these studies, new metrics, including stress hyperglycemia ratio (SHR), glycemic gap, or glucose concentration‐to‐hemoglobin A 1C ratio (GAR), were used to represent stress hyperglycemia.…”

Section: Introductionmentioning

confidence: 99%

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Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission

Liu

Chen

et al. 2023

Journal of Diabetes

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Backgrounds: Stress hyperglycemia ratio (SHR) reflects the acute blood glucose change in response to acute illnesses or injuries, including pneumonia.We aimed to investigate the associations of SHR with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission.Methods: A multicenter and retrospective study was conducted among diabetic inpatients with pneumonia on admission via electronic medical records from 2013 to 2019 in Ruijin Hospital, Shengjing Hospital, and China-Japan Friendship Hospital. Results: The study included 1631 diabetic inpatients with pneumonia on admission. Patients of the fourth quartile (Q4) of SHR on admission showed significantly elevated systemic inflammation compared with those of the first quartile (Q1), second quartile (Q2), or third quartile (Q3) of SHR, including more white blood cells (9.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission

Liu

Chen

et al. 2023

Journal of Diabetes

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“…In the absence of background glucose level as a context, SIH alone may not be a valid predictor of POD in non-diabetic patients. GG has been used to eliminate the effect of hyperglycemia existing before stress conditions [ 50 ]. Patients with high GG have been found to have increased mortality [ 29 , 31 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Type 2 Diabetes Mellitus with Tight Glucose Control and Poor Pre-Injury Stair Climbing Capacity May Predict Postoperative Delirium: A Secondary Analysis

et al. 2022

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(1) Background: Previous evidence demonstrates that tight glycemic control and good physical function could reduce the risk of delirium. This study aimed to investigate whether the occurrence of postoperative delirium (POD) in older hip fracture surgery patients is associated with preoperative glycemic control factors or pre-injury physical performance. (2) Methods: Three-hundred and nine individuals aged over 65 years and scheduled for hip fracture surgery were included at a single center. Glycemic control factors and pre-injury physical performance were assessed preoperatively. The presence of delirium was assessed using the Confusion Assessment Method on postoperative hospitalization days. Univariate and multivariable logistic regression models and a risk prediction model of POD were established. (3) Results: Among the 309 patients, 52 (16.83%) experienced POD during the hospital stay. The numbers of pre-injury physical performance and type 2 diabetes mellitus (T2DM) patients were significantly different in the POD and non-POD groups. The multivariable model showed that development of delirium was significantly explained by preoperative fasting blood glucose (FBG) (OR 0.804, p = 0.004), stair climbing (OR 0.709, p = 0.003), T2DM (odds ratio (OR) 3.654, p = 0.001), and age-adjusted Charlson comorbidity index (ACCI) (OR 1.270, p = 0.038). The area under the receiver operating characteristic curve (AUROC) of the risk prediction model including those covariates was 0.770. (4) Conclusions: More older T2DM patients develop POD after hip fracture surgery than patients without T2DM. A simple assessment of preoperative FBG and pre-injury stair climbing capacity may identify those at high risk for the development of POD. Higher preoperative FBG and good pre-injury stair climbing capacity are protective factors for POD.

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“…Using the Kruskal–Wallis test, a total sample of 45 subjects are required to achieve a power of 0.900 with a target significance of 0.050. Considering the prevalence of sepsis was 44% for the critically-ill population in our previous work [ 32 ], we need to screen at least 102 patients admitted to ICU to complete this study.…”

Section: Methodsmentioning

confidence: 99%

Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients

Chou

Wang

et al. 2021

j intensive care

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Background Trimethylamine N-oxide (TMAO) is a microbiota-derived metabolite, which is linked to vascular inflammation and atherosclerosis in cardiovascular (CV) diseases. But its effect in infectious diseases remains unclear. We conducted a single-center prospective study to investigate association of TMAO with in-hospital mortality in septic patients admitted to an intensive care unit (ICU). Methods Totally 95 septic, mechanically ventilated patients were enrolled. Blood samples were obtained within 24 h after ICU admission, and plasma TMAO concentrations were determined. Septic patients were grouped into tertiles according to TMAO concentration. The primary outcome was in-hospital death, which further classified as CV and non-CV death. Besides, we also compared the TMAO concentrations of septic patients with 129 non-septic patients who were admitted for elective coronary angiography (CAG). Results Septic patients had significantly lower plasma TMAO levels than did subjects admitted for CAG (1.0 vs. 3.0 μmol/L, p < 0.001). Septic patients in the lowest TMAO tertile (< 0.4 μmol/L) had poorer nutrition status and were given longer antibiotic courses before ICU admission. Circulating TMAO levels correlated positively with daily energy intake, the albumin and prealbumin concentration. Compared with those in the highest TMAO tertile, septic patients in the lowest TMAO tertile were at greater risk of non-CV death (hazard ratio 2.51, 95% confidence interval 1.21–5.24, p = 0.014). However, TMAO concentration was no longer an independent predictor for non-CV death after adjustment for disease severity and nutritional status. Conclusion Plasma TMAO concentration was inversely associated with non-CV death among extremely ill septic patients, which could be characterized as TMAO paradox. For septic patients, the impact of malnutrition reflected by circulating TMAO levels was greater than its pro-inflammatory nature.

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The paradox of the glycemic gap: Does relative hypoglycemia exist in critically ill patients?

Cited by 14 publications

References 32 publications

Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission

Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission

Type 2 Diabetes Mellitus with Tight Glucose Control and Poor Pre-Injury Stair Climbing Capacity May Predict Postoperative Delirium: A Secondary Analysis

Paradox of trimethylamine-N-oxide, the impact of malnutrition on microbiota-derived metabolites and septic patients

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