Hypoglycemia and mortality in sepsis patients: A systematic review and meta-analysis

Wang, Jing; Zhu, Chengkai; Yu, Jiangquan; Tan, Rui; Pan, Yang

doi:10.1016/j.hrtlng.2021.07.017

Cited by 28 publications

(25 citation statements)

References 36 publications

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“…These data are consistent with previous endotoxemia data, which revealed that mitochondrial dysfunction may reduce noncarbohydrate precursor use and glucose production and eventually cause hypoglycemia [18]. Notably, a correlation between systemic inflammation, hypoglycemia, and mortality in patients with severe sepsis has been reported [19,20]. Considering the results of these reports [17][18][19][20], our observation of significant mortality in endotoxin-treated obese mice in this study is reasonable.…”

Section: Discussionsupporting

confidence: 92%

“…Notably, a correlation between systemic inflammation, hypoglycemia, and mortality in patients with severe sepsis has been reported [19,20]. Considering the results of these reports [17][18][19][20], our observation of significant mortality in endotoxin-treated obese mice in this study is reasonable. Moreover, because exosomes can mitigate systemic inflammation and somewhat alleviate severe hypoglycemia, our observation that exosomes improved survivorship in endotoxin-treated obese mice was also reasonable.…”

Section: Discussionsupporting

confidence: 69%

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Let-7i-5p Mediates the Therapeutic Effects of Exosomes from Human Placenta Choriodecidual Membrane-Derived Mesenchymal Stem Cells on Mitigating Endotoxin-Induced Mortality and Liver Injury in High-Fat Diet-Induced Obese Mice

et al. 2021

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Obesity complicates sepsis and increases the mortality of sepsis. We examined the effects of exosomes (from human placenta choriodecidual membrane-derived mesenchymal stem cells, pcMSCs) on preventing sepsis in obesity and the mitigating role of hsa-let-7i-5p microRNA. Obese mice (adult male C57BL/6J mice fed a high-fat diet for 12 weeks) received normal saline (HFD), endotoxin (10 mg/kg, intraperitoneal (ip); HFDLPS), endotoxin with exosomes (1 × 108 particles/mouse, ip; HLE), or endotoxin with let-7i-5p microRNA inhibitor-pretreated exosomes (1 × 108 particles/mouse, ip; HLEi). Our data demonstrated that the 48-h survival rate in the HLE (100%) group was significantly higher than in the HFDLPS (50%) and HLEi (58.3%) groups (both p < 0.05). In the surviving mice, by contrast, levels of liver injury (injury score, plasma aspartate transaminase and alanine transaminase concentrations, tissue water content, and leukocyte infiltration in liver tissues; all p < 0.05), inflammation (nuclear factor-κB activation, hypoxia-inducible factor-1α activation, macrophage activation, and concentrations of tumor necrosis factor-α, interleukin-6, and leptin in liver tissues; all p < 0.05), and oxidation (malondialdehyde in liver tissues, with p < 0.001) in the HLE group were significantly lower than in the HFDLPS group. Levels of mitochondrial injury/dysfunction and apoptosis in liver tissues in the HLE group were also significantly lower than in the HFDLPS group (all p < 0.05). Inhibition of let-7i-5p microRNA offset the effects of the exosomes, with most of the aforementioned measurements in the HLEi group being significantly higher than in the HLE group (all p < 0.05). In conclusion, exosomes mitigated endotoxin-induced mortality and liver injury in obese mice, and these effects were mediated by let-7i-5p microRNA.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 69%

Let-7i-5p Mediates the Therapeutic Effects of Exosomes from Human Placenta Choriodecidual Membrane-Derived Mesenchymal Stem Cells on Mitigating Endotoxin-Induced Mortality and Liver Injury in High-Fat Diet-Induced Obese Mice

et al. 2021

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“…The possible mechanisms underlying the association between higher acute GV and increased risk of mortality may be multifactorial. Firstly, patients with increased acute GV are more likely to suffer from stress-induced hyperglycemia as well as hypoglycemic events, both of which have been shown to be important predictors of mortality in patients with sepsis [ 9 , 10 ]. In addition, degree of acute GV may reflect the severity of sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that glycemic disorders may adversely affect the prognosis in patients with sepsis [ 7 , 8 ]. For example, both stress hyperglycemia and hypoglycemic events have been related to increased risk of death in patients with sepsis [ 9 , 10 ]. Interestingly, recent evidence suggests that higher acute glycemic variability (GV), which reflects increased fluctuation in glycemia within or between days, may also be a strong risk factor for mortality in patients with critical illnesses, including sepsis [ 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Acute glycemic variability and risk of mortality in patients with sepsis: a meta-analysis

Li¹,

Zhang

Chen³

et al. 2022

Diabetol Metab Syndr

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Background Acute glycemic variability (GV) has been correlated with the severity of sepsis. The aim of the study was to evaluate the potential association between acute GV and mortality risk in patients with sepsis. Methods Cohort studies comparing the risk of death within 3 months between septic patients with higher versus lower acute GV were retrieved by systematic search of Medline, Embase, Web of Science, Wanfang and CNKI databases. We used a random-effect model to pool the data by incorporating the between-study heterogeneity. Sensitivity analyses were performed to evaluate the stability of the findings. Results Ten studies including 4296 patients were available for the meta-analysis. Pooled results showed that septic patients with higher acute GV had significantly increased mortality risk compared to those with lower acute GV, as evidenced by results using different parameters including standard deviation of blood glucose (SDBG, risk ratio [RR]: 1.74, 95% confidence interval [CI] 1.36–2.24, p < 0.001; I2 = 0%), coefficient of variation of blood glucose (RR: 1.91, 95% CI 1.57–2.31, p < 0.001; I2 = 0%), mean amplitude of glycemic excursion (RR: 1.81. 95% CI 1.36–2.40, p < 0.001; I2 = 0%), and glycemic lability index (RR: 2.52, 95% CI 1.72–3.68, p < 0.001; I2 = 0%). Sensitivity analyses by excluding one study at a time did not significantly affect the results (p all < 0.05). Conclusions Higher acute GV may be a predictor of mortality risk in patients with sepsis.

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“…Hypoglycemia has been found to be a poor prognostic indicator in previous studies. It is independently associated with higher mortality in the setting of sepsis and may indicate early sepsis and in-hospital deterioration in some clinical scenarios [3][4][5]. Prior retrospective studies have suggested increased mortality in patients with chronic liver disease who develop in-hospital hypoglycemia [6].…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia Is Associated With Worse Outcomes in Patients With Cholangitis Despite Undergoing Endoscopic Retrograde Cholangiopancreatography

Obeidat¹,

Mahfouz²,

Benavente³

et al. 2022

Cureus

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BackgroundHypoglycemia has been associated with poorer outcomes in hospitalized patients undergoing surgical interventions. In cholangitis, endoscopic retrograde cholangiopancreatography (ERCP) is often a critical adjunct to surgery, capable of diagnosing and treating various biliary and pancreatic pathologies. While technically less invasive than surgery, the effect of hypoglycemia on clinical outcomes of patients with cholangitis undergoing ERCP has not been elucidated. MethodologyData were extracted from the National Inpatient Sample (NIS) database from 2016 to 2019. Using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, patients diagnosed with cholangitis and underwent ERCP were identified. Baseline demographic data, comorbidities, in-hospital mortality, hospital charges, and hospital length of stay (LOS) were extracted and compared based on the presence or absence of hypoglycemia. Statistical analysis was done using t-test and chi-square analyses. A multivariate analysis for the mortality odds ratio (OR) was calculated to adjust for possible confounders. ResultsA total of 256,540 patients with cholangitis who underwent ERCP were identified, and 2,810 of them had hypoglycemia during their hospitalization. The mean age of the hypoglycemia group was 64.41 years. Most patients were females (54%) and whites (57%). More patients in the hypoglycemia group had a history of alcoholism and congestive heart failure (CHF). Hypoglycemia was associated with higher odds of in-hospital mortality (OR = 6.71, confidence interval (CI) = 5.49-8.2; p < 0.0001). In addition to hypoglycemia, age >65 years, non-white race, and CHF were independently associated with higher mortality. Moreover, patients with hypoglycemia had higher total hospital charges

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Hypoglycemia and mortality in sepsis patients: A systematic review and meta-analysis

Cited by 28 publications

References 36 publications

Let-7i-5p Mediates the Therapeutic Effects of Exosomes from Human Placenta Choriodecidual Membrane-Derived Mesenchymal Stem Cells on Mitigating Endotoxin-Induced Mortality and Liver Injury in High-Fat Diet-Induced Obese Mice

Let-7i-5p Mediates the Therapeutic Effects of Exosomes from Human Placenta Choriodecidual Membrane-Derived Mesenchymal Stem Cells on Mitigating Endotoxin-Induced Mortality and Liver Injury in High-Fat Diet-Induced Obese Mice

Acute glycemic variability and risk of mortality in patients with sepsis: a meta-analysis

Hypoglycemia Is Associated With Worse Outcomes in Patients With Cholangitis Despite Undergoing Endoscopic Retrograde Cholangiopancreatography

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