Relative Hyperglycemia, a Marker of Critical Illness: Introducing the Stress Hyperglycemia Ratio

Roberts, G. W.; Quinn, Stephen; Valentine, Nyoli; Alhawassi, Tariq M.; O'Dea, Hazel; Stranks, Stephen N; Burt, Morton G.; Doogue, Matthew

doi:10.1210/jc.2015-2660

Cited by 222 publications

(255 citation statements)

References 35 publications

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“…Although Δ A−C reflects absolute acute glycemic changes and does not take into account the patient chronic glycometabolic profile, the A/C glycemic ratio considers acute glycemic variation and DM status. Consequently, patients with similar absolute acute glycemic rise (Δ A−C ) may have different A/C glycemic ratios, according to their chronic values 31, 32. A patient with Δ A−C of 200 mg/dL, for example, may have an A/C glycemic ratio of 2 in case of an admission value of 400 mg/dL and a chronic glycemic value of 200 mg/dL.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

Marenzi

Cosentino

Milazzo

et al. 2018

JAHA

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BackgroundIn acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.Methods and ResultsAt admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)−46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA−C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA−C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55–0.69]; P=0.001) and ΔA−C (area under the curve: 0.62 [95% confidence interval, 0.54–0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA−C to acute glycemia allowed proper AKI risk prediction in 16% of patients.ConclusionsIn diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.

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Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

Marenzi

Cosentino

Milazzo

et al. 2018

JAHA

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“…Nonetheless, a large study with ≈10 000 patients concluded that fasting plasma glucose >100 mg/dL and/or hypertension were not significantly associated with all‐cause mortality; however, the study was limited to patients with non–ST‐elevation MI and had limited follow‐up 8. Measurement of glucose levels during stress hyperglycemia, such as an acute coronary event or heart failure, is pathophysiologically different; it may possibly serve as a different marker when compared with fasting glucose obtained during a scheduled non–event‐related visit 42, 43, 44…”

Section: Discussionmentioning

confidence: 99%

Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease

Younis

Goldkorn

Goldenberg

et al. 2017

JAHA

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BackgroundWe wanted to explore the association of metabolic syndrome (MetS) versus its individual components with 20‐year all‐cause mortality among patients with stable coronary artery disease.Methods and ResultsThe cohort comprised 12 403 nondiabetic patients with stable coronary artery disease who were enrolled in the Bezafibrate Infarction Prevention Registry between February 1990 and October 1992 and followed up through December 2014. The study cohort was divided into 4 groups: patients without MetS or impaired fasting glucose (IFG), patients with IFG but without MetS, patients with MetS but without IFG, and patients with both MetS and IFG. Kaplan‐Meier survival analysis showed that at 20 years of follow‐up, the rates of all‐cause mortality were the highest among patients with both MetS and IFG (66%). Patients with IFG without MetS experienced a significantly higher mortality rate compared with those with MetS without IFG (61% versus 56%; log‐rank P<0.001). Multivariable Cox proportional hazard analysis showed that the final Cox model demonstrated that the additive effect of MetS (hazard ratio, 1.13; 95% confidence interval, 1.1–1.16; P=0.02) and IFG (hazard ratio, 1.54; 95% confidence interval, 1.46–1.62; P<0.001) on 20 years mortality was nonsignificant (hazard ratio, 1.01; 95% confidence interval, 0.93–1.11; P=0.69). IFG was associated with the most pronounced increase in mortality risk among the individual components (hazard ratio, 1.22; 95% confidence interval, 1.14–1.3; P<0.001).ConclusionsOur findings suggest that IFG alone is a major independent predictor of long‐term mortality among patients with stable coronary artery disease versus other components of the MetS.

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“…Stress hyperglycemia can be a transient finding in hospitalized or ill patients, and is categorized by patients with and without evidence of preexisting diabetes [38]. Patients with newly diagnosed hyperglycemia are more likely to be admitted to the ICU with critical illness, experience longer hospital stays, and are less likely to be discharged home [38][39][40]. Our patient did carry a previous diagnosis of DM2, but had a history of poor glycemic control.…”

Section: Glycosylated Hemoglobinmentioning

confidence: 84%

Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition

Blank

Rothstein

Lee

et al. 2017

J Vasc Endovasc Surg

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Context: Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report two cases of aortobifemoral bypass graft malposition through the colon.Case report: Case 1 is a 54 year old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately six months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60 year old male who underwent aorto bifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately ten weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum. Conclusions:Aortic graft infection is usually caused by surgical contamination, and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.

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Relative Hyperglycemia, a Marker of Critical Illness: Introducing the Stress Hyperglycemia Ratio

Cited by 222 publications

References 35 publications

Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease

Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition

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