Glucose dysmetabolism and prognosis in critical illness

Lazzeri, Chiara; Tarquini, Roberto; Giunta, Francesco; Gensini, Gian Franco

doi:10.1007/s11739-008-0206-3

Cited by 28 publications

(22 citation statements)

References 74 publications

(93 reference statements)

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“…AMI is an acute metabolic stress, 3 and elevated blood glucose concentration is not simply a marker of pre-existing diabetes or glucose intolerance, but may represent a stress response to myocardial injury mainly related to acute catecholamine release. 4,5 In the setting of this acute metabolic stress, insulin resistance, as assessed by the HOMA index, has been recently shown to be quite common in patients without previously known diabetes and STEMI, and it has been proved an independent predictor of in-hospital mortality. 6 In elderly patients with AMI, who show a high prevalence of known and unrecognised diabetes, elevated glucose is common, rarely treated, 7 and is associated with a much greater increase in the risk of death among AMI patients without antecedent history of diabetes, compared with diabetics.…”

Section: Introductionmentioning

confidence: 99%

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Lazzeri

Valente

Chiostri

et al. 2010

Diabetes and Vascular Disease Research

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In elderly patients with AMI, hyperglycaemia is associated with increased mortality. Recently it has been observed that insulin resistance, as assessed by the HOMA index, proved an independent predictor of in-hospital mortality. The interaction between age and glucose metabolism response in the acute phase of patients with STEMI without previously known diabetes has not yet been explored. We aimed to assess this relationship in 346 consecutive patients with STEMI admitted to our ICCU after primary PCI.When compared with the other age subgroups, the very oldest patients (aged > 79 years) showed the lowest LVEF (p=0.011), the highest incidence of 2-and 3-vessel coronary artery disease (p=0.002), and, finally, the highest mortality (p=0.037). Advancing age was associated with increased values of fibrinogen (p=0.022) and ESR (p=0.001), as well as of NT-pro-BNP (p<0.001). The very oldest patients (aged > 79 years) exhibited the highest values of glycaemia and peak glycaemia, while the incidence of insulin resistance (as inferred by HOMA index) remained unchanged across the age subgroups. This glycaemic pattern was confirmed after exclusion of patients with HbA 1c > 6.5%, that is patients with a poor glycaemic control in the previous 2-3 months.In the acute phase of STEMI acute glucose metabolism is affected by age, since older patients showed the highest glucose levels and the poorest glycaemic control during ICCU stay despite the lack of differences in insulin resistance incidence.

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Section: Introductionmentioning

confidence: 99%

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Lazzeri

Valente

Chiostri

et al. 2010

Diabetes and Vascular Disease Research

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“…Все эти изменения приводят к сни-жению бактерицидной активности крови. ГГ вызывает увеличение выработки провоспалительных факторов, ин-терлейкинов-6 и -18, С-реактивного белка, ФНО-α [14].…”

Section: иммунная системаunclassified

Hyperglycaemia in criticaly ill patients

Клыпа¹,

Orehova²,

Zabrosaeva³

2015

Diabetes mellitus

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© Сахарный диабет, 2015Вопросы патогенеза трессовая гипергликемия (ГГ) является неиз-бежным спутником критических состояний и представляет одну из наиболее актуаль-ных проблем современной интенсивной медицины. По данным различных авторов, частота развития ГГ у пациентов, находящихся в критическом состоянии, превышает 90%. При этом появляется все больше ис-следований, подтверждающих негативное влияние ГГ на результаты лечения пациентов в различных областях медицины [1].Под критическими состояниями в контексте данной проблемы понимают обширные оперативные вмеша-тельства, острые заболевания, состояния, угрожающие жизни и требующие проведения интенсивной терапии, массивные травмы.Актуальность проблемы основывается на значимой взаимосвязи между ГГ стресса и увеличением летально-сти и количества осложнений у больных в критическом состоянии. Вместе с тем, существуют данные о том, что контроль и адекватная коррекция ГГ приводят к улуч-шению результатов лечения [2]. Очевидно, что именно контроль метаболизма глюкозы является одним из ос-новных факторов, определяющих исходы критических состояний у всех категорий больных, а не только у боль-ных сахарным диабетом (СД) [3]. Более того, больные с выраженной стресс-ГГ без предшествующего СД имеют Гипергликемия критических состояний

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“…Acute insulin resistance is known to be part of the glyco-metabolic response to stress [36], but few studies assessed the role of insulin resistance, evaluated by means of Homeostatic Model Assessment (HOMA index), in the early phase of acute myocardial infarction [37,38].…”

Section: Acute Insulin Resistance In the Early Phase Of Stemimentioning

confidence: 99%

Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization

Lazzeri

Valente

Chiostri

et al. 2012

International Journal of Cardiology

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Though age is a predictor of adverse events after acute coronary syndrome, including in-hospital and posthospital mortality rates, elderly patients are under-represented in randomized trials evaluating strategies of early coronary revascularization in acute myocardial infarction. Several factors can account for the unfavorable outcome of the elderly, comprising increased glucose values. Diabetes is more common in the elderly patients with acute myocardial infarction in respect to younger patients and elevated glucose, though common, are rarely treated and associated with increased mortality, particularly in those without recognized diabetes. Age itself is thought to affect the acute glucose response to stress. Human aging is associated with impaired β-cell sensitivity to glucose and impaired β-cell compensation to insulin resistance and older people exhibit an impaired glucose response after injury characterized by a more marked increases in endogenous glucose production. In the early phase of ST elevation myocardial infarction (STEMI), the acute glucose response to stress comprises not only hyperglycemia but also insulin-resistance (assessed by the Homeostatic Model Assessment). Recently it has been documented in 346 STEMI patients submitted to mechanical revascularization that the acute glucose response to myocardial injury differs in respect to age, since older patients showed the highest glucose levels and the poorest glycemic control during ICCU stay in the lack of differences in insulin resistance incidence. Taking into account that aging impairs the acute glucose response to stress in elderly STEMI patients, further studies are needed to establish whether a different (more aggressive) therapeutic regime is needed in this subgroup of patients at higher risk.

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Glucose dysmetabolism and prognosis in critical illness

Cited by 28 publications

References 74 publications

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Hyperglycaemia in criticaly ill patients

Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization

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