Prognostic Significance of Plasma Insulin Level for Deep Venous Thrombosis in Patients with Severe Traumatic Brain Injury in Critical Care

Du, Ming; Zhang, Qinghong; Tang, Rui; Liu, Haiyan; Ji, Zong-Shu; Gao, Zhi; Wang, Ying; You, He-Yang; Hao, Jiaao; Zhou, Min

doi:10.1007/s12028-022-01588-y

Cited by 3 publications

(5 citation statements)

References 89 publications

(52 reference statements)

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“…Throughout the 14 days, the plasma level of GLP-1 was increased exclusively in non-survivors; on the contrary, insulin remained at a consistent level in non-survivors even though they were more likely to receive insulin therapy (Table 1, p = 0.043). Actually, patients receiving insulin therapy had higher plasma GLP-1 level than patients without ( p = 0.010) [79], indicating the central GLP-1 resistance underlying insulin resistance in patients with TBI.…”

Section: Discussionmentioning

confidence: 99%

“…Data were collected as part of the previous study [79]. Patients with TBI ( n = 73) were prospectively recruited between January 2019 and July 2020 in a 28-bed neuro-ICU at the First Affiliated Hospital of the University of Science and Technology of China (USTC).…”

Section: Methodsmentioning

confidence: 99%

“…We followed the standardized diagnostic and therapeutic regimen as we previously reported [79]. In summary, our multimodal monitoring protocol in the neuro-ICU included hourly neurologic monitoring, continuous invasive blood pressure measurement, daily optical nerve monitoring to keep the diameter between 0.55 and 0.57 cm (Vivid TM iq; GE Healthcare, Beijing, China) [80], cerebral hemodynamic monitoring by transcranial Doppler (DWL, Doppler Box, Germany), quantitative electroencephalogram, ultrasound surveillance of deep venous thrombosis (Vivid TM iq; GE Healthcare) [81, 82].…”

Section: Methodsmentioning

confidence: 99%

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Central GLP-1 Resistance Induced by Severe Traumatic Brain Injury Was Associated with Persistent Hyperglycemia in Humans

Zhou¹,

DU²,

Tang³

et al. 2023

Neuroendocrinology

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Introduction: Whether central glucagon-like peptide 1 (GLP-1)/GLP-1 receptor system mediated peripheral glucose homeostasis in patients with traumatic brain injury (TBI) is not clear. We aim to determine if plasma GLP-1 level could distinguish the non-survivors from the survivors during the first 14 days after TBI that could prognose 6 months mortality. Methods: Metabolic, inflammatory, and hematological profiles were examined in 73 patients with TBI in neuro-ICU. Factors that discriminate non-survivors from survivors were determined by Two-way ANOVA. Biomarkers associated with mortality were determined by Binary logistic regression and Cox proportional hazard regression. Results: The non-survivors had higher infectious SOFA scores (P<0.001), lower first 3 days’ body temperature (P=0.017), greater chance of cerebral hernia (P=0.048) and decompressive craniectomy (P=0.001) than the survivors. Higher 14-days plasma GLP-1 (P<0.0001), glucose (P=0.002) and IL-6 (P=0.005) levels, in contrast with lower insulin level at days 4-7 (P=0.020) were found in non-survivors than in survivors. Except the survivors had an increased 14-days platelet number (P<0.001), the two groups did not differ in hematological profile and intestinal barrier function. Although GLP-1 correlated closely with IL-6 in both the two groups, it correlated with neither insulin nor glucose in each group. GLP-1 on days 8-10 and IL-6 on days 1-3 were positively, while insulin on days 4-7 was negatively associated with mortality. Conclusion：Persistent higher GLP-1 level in non-survivors over the survivors may present more severe central resistance to endogenous GLP-1 in non-survivors, which may be associated with progressive hyperglycemia with increased mortality in TBI.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Central GLP-1 Resistance Induced by Severe Traumatic Brain Injury Was Associated with Persistent Hyperglycemia in Humans

Zhou¹,

DU²,

Tang³

et al. 2023

Neuroendocrinology

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“…Описаны независимые предикторы ВТЭО у пациентов с ЧМТ: высокий уровень тромбоцитов, гиперкоагуляция, высокий индекс массы тела, пожилой возраст, тяжелая ЧМТ, катетеризация магистральных вен и ряд других [23,30]. В литературе приводятся также такие факторы, как уровни инсулина и витамина D в крови, оказывающие непосредственное влияние на развитие ВТЭО при ЧМТ [21,31].…”

Section: нейрохирургияunclassified

Venous thromboembolism in patients with isolated moderate to severe traumatic brain injury

Khripun,

Pryamikov,

Asratyan

et al. 2024

Nejrohirurgiâ (Mosk.)

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Background. Traumatic brain injury (TBI) remains a big problem of modern neurosurgery, accompanied by high rates of disability and lethality. Venous thromboembolism (VTE) including venous thrombosis and pulmonary embolism (PE) plays a significant role in the structure of mortality in this pathology. Regimens and schemes of pharmacological prevention of VTE in TBI as well as corresponding preventative measures are not yet determined completely.Aim. To identify the frequency of VTE in patients with isolated moderate and severe TBI, and to evaluate the results of prevention and treatment of these complications in patients of this category.Materials and methods. Over a 3‑year period (from 2020 to 2023) 73 patients with isolated moderate and severe TBI (51 men and 22 women, mean age 61.0 ± 13.0 years) were treated in the V. M. Buyanov City Clinical Hospital. Of these, 31 patients received only conservative therapy, and 42 patients underwent surgery (craniotomy with hematoma removal, closed external hematoma drainage, and installation of intracranial pressure sensor). Ultrasound examination of the lower limb veins was performed at patient admission, then every 7 days until discharge from the hospital. Pharmacological prevention of VTE using low molecular weight heparin in non‑surgical patients was started after 1–2 days if computed tomography of the brain 24 h after admission showed no negative hematoma dynamics. Surgical patients were prescribed preventive medications 24 h after surgery if computed tomography confirmed intracranial hemostasis.Results. Venous thrombosis was detected in 22 (30.1 %) of 73 patients. PE complicated the underlying disease in 1 (1.4 %) case and was non‑fatal. There was no fatal PE in the study group. An increase of the initial intracranial hematoma volume occurred in 3 (4.1 %) patients, in 2 (2.8 %) patients the recurrence of hemorrhage occurred before the beginning of heparin administration, and in 1 (1.4 %) case against the background of therapeutic doses of anticoagulants prescribed for venous thrombosis. In the majority of cases (82.0 %; 18 of 22 patients) thromboses were localized in deep veins of the lower leg and were asymptomatic. Intrahospital mortality was 23.3 % (17 patients), all lethal outcomes were due to the course of traumatic brain disease.Conclusion. VTE is a frequent complication of TBI with intracranial hemorrhage. Regular ultrasound diagnostics makes it possible to diagnose asymptomatic distal venous thrombosis in a timely manner and to prescribe therapeutic doses of low molecular weight heparin in time which in turn allows to avoid fatal PE. Currently, there are no clear domestic recommendations for the prevention and, most importantly, for the treatment of these complications in patients with isolated moderate and severe TBI, which requires further active study of this problem.

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“…Other studies suggest tight glycemic endpoint control (via infusion) with the resultant blood glucose endpoint of between 150 mg/dL and 180 mg/dL [7]. This glycemic level appears to further improve patient outcomes in both pre-and post-operative settings [8]. Although this empirical treatment application has been shown to be effective, the underlying mechanism(s) associated with microbial sepsis under various glycemic conditions vis-à-vis insulin levels has not been determined.…”

Section: Introductionmentioning

confidence: 99%

The Role of the Insulin/Glucose Ratio in the Regulation of Pathogen Biofilm Formation

Plotkin,

Halkyard,

Spoolstra

et al. 2023

Biology

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During the management of patients in acute trauma the resulting transient hyperglycemia is treated by administration of insulin. Since the effect of insulin, a quorum sensing compound, together with glucose affects biofilm formation in a concentration-specific manner, we hypothesize that the insulin/glucose ratio over the physiologic range modulates biofilm formation potentially influencing the establishment of infection through biofilm formation. Methods: A variety of Gram-positive and Gram-negative bacteria were grown in peptone (1%) yeast nitrogen base broth overnight in 96-well plates with various concentrations of glucose and insulin. Biofilm formation was determined by the crystal violet staining procedure. Expression of insulin binding was determined by fluorescent microscopy (FITC-insulin). Controls were buffer alone, insulin alone, and glucose alone. Results: Overall, maximal biofilm levels were measured at 220 mg/dL of glucose, regardless of insulin concentration (10, 100, 200 µU/mL) of the organism tested. In general, insulin with glucose over the range of 160–180 mg/dL exhibited a pattern of biofilm suppression. However, either above or below this range, the presence of insulin in combination with glucose significantly modulated (increase or decrease) biofilm formation in a microbe-specific pattern. This modulation appears for some organisms to be reflective of the glucose-regulated intrinsic expression of bacterial insulin receptor expression. Conclusion: Insulin at physiologic levels (normal and hyperinsulinemic) in combination with glucose can affect biofilm formation in a concentration-specific and microbe-specific manner. These findings may provide insight into the importance of co-regulation of the insulin/glucose ratio in patient management.

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Prognostic Significance of Plasma Insulin Level for Deep Venous Thrombosis in Patients with Severe Traumatic Brain Injury in Critical Care

Cited by 3 publications

References 89 publications

Central GLP-1 Resistance Induced by Severe Traumatic Brain Injury Was Associated with Persistent Hyperglycemia in Humans

Central GLP-1 Resistance Induced by Severe Traumatic Brain Injury Was Associated with Persistent Hyperglycemia in Humans

Venous thromboembolism in patients with isolated moderate to severe traumatic brain injury

The Role of the Insulin/Glucose Ratio in the Regulation of Pathogen Biofilm Formation

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