A systematic scoping review on the consequences of stress-related hyperglycaemia

Abstract

BackgroundStress-related hyperglycaemia (SHG) is commonly seen in acutely ill patients and has been associated with poor outcomes in many studies performed in different acute care settings. We aimed to review the available evidence describing the associations between SHG and different outcomes in acutely ill patients admitted to an ICU. Study designs, populations, and outcome measures used in observational studies were analysed.MethodsWe conducted a systematic scoping review of observational studies following the Joanna Briggs methodology. Medline, Embase, and the Cochrane Library were searched for publications between January 2000 and December 2015 that reported on SHG and mortality, infection rate, length of stay, time on ventilation, blood transfusions, renal replacement therapy, or acquired weakness.ResultsThe search yielded 3,063 articles, of which 43 articles were included (totalling 536,476 patients). Overall, the identified studies were heterogeneous in study conduct, SHG definition, blood glucose measurements and monitoring, treatment protocol, and outcome reporting. The most frequently reported outcomes were mortality (38 studies), ICU and hospital length of stay (23 and 18 studies, respectively), and duration of mechanical ventilation (13 studies). The majority of these studies (40 studies) compared the reported outcomes in patients who experienced SHG with those who did not. Fourteen studies (35.9%) identified an association between hyperglycaemia and increased mortality (odds ratios ranging from 1.13 to 2.76). Five studies identified hyperglycaemia as an independent risk factor for increased infection rates, and one identified it as an independent predictor of increased ICU length of stay.DiscussionSHG was consistently associated with poor outcomes. However, the wide divergences in the literature mandate standardisation of measuring and monitoring SHG and the creation of a consensus on SHG definition. A better comparability between practices will improve our knowledge on SHG consequences and management.

Does poor glucose control increase the severity and mortality in patients with diabetes and COVID-19?

“…This suggest that stress hyperglycemia (defined by the American Diabetes Association [6] as a transient elevation in blood glucose in the setting of acute illness or after surgery in a patient with an A1C < 6.5%), may have a worser outcome in acute illness, compared to a previously diagnosed diabetes. This finding is not unexpected, given that the similar worser outcome was observed with stress hyperglycemia in previous meta-analyses [7,8]. Interestingly, stress hypoglycemia was one of the poor prognostic factors and had been associated with a significant increase in respiratory failure and death during the SARS-CoV-1 outbreak in 2003e2004, along with the diabetes [9].…”

Factors leading to high morbidity and mortality of COVID‐19 in patients with type 2 diabetes

“…45 Acute (stress) hyperglycemia per se in the setting of severe illness or surgery is associated with longer length of hospital stay, higher infection rates, longer duration of ventilator management, and increased mortality. 47 Stress hyperglycemia occurs in individuals without diabetes and is thought to result from a surge of catecholamines and especially cortisol in response to acute stress. 48 In COVID-19 illness, direct damage of β-cells due to entry of the virus through cell surface ACE2 protein can lead to cell damage and apoptosis causing relative insulin deficiency and acute hyperglycemic state.…”

Update on glucose in critical care

“…From large epidemiologic studies, BG concentrations are raised in severely ill patients, in different settings including emergency departments [23,24], ICUs [14,25,26], and cardiac care units [27]. Observational studies have documented that hyperglycemia after cardiothoracic surgical procedures is associated with twofold increases of the incidence of wound infection [28,29].…”