Severe hypoglycemia associated with insulin-like growth factor II-producing liver metastasis from gastric carcinoma treated with overnight total parenteral nutrition via a central vein catheter reserve port

Hiraoka, Atsushi; Michitaka, Kojiro; Tazuya, Nayu; Ichiryu, Misa; Nakahara, Hiromasa; Ochi, Hironori; Tanabe, Atsushi; Hidaka, Shigekazu; Kodama, Akihiro; Uehara, Takeki; Hasebe, Aki; Miyamoto, Yoshinori; Nakamura, Tomoyuki; Kumagi, Teru; Abe, Masanori; Matsuura, Bunzo; Horiike, Norio; Hiasa, Yoichi; Onji, Morikazu

doi:10.1007/s12328-010-0200-y

Cited by 2 publications

(2 citation statements)

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“…Parenteral nutrition is often used for tumor patients who cannot eat or have insufficient food intake and for those who experience adverse reactions such as vomiting, diarrhea, leading to malnutrition. These patients often have hypovolemia, and the infusion of high-concentration nutrients will further increase blood viscosity[ 13 ]. Increased blood viscosity slows blood flow and increases the risk of thrombosis formation.…”

Section: Discussionmentioning

confidence: 99%

Establishment and validation of a predictive model for peripherally inserted central catheter-related thrombosis in patients with liver cancer

Chen,

Wu,

et al. 2024

World J Gastrointest Surg

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BACKGROUND Peripherally inserted central catheters (PICCs) are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy, nutrition, and other medications. However, PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population. Several risk factors have been identified for the development of PICC-related thrombosis, including cancer type, stage, comorbidities, and catheter characteristics. Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis. AIM To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer, construct a predictive model, and validate it. METHODS Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected. Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected, and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls. A total of 255 samples were collected and used as the training set, and 77 cases were collected as the validation set in a 7:3 ratio. General patient information, case data, catheterization data, coagulation indicators, and Autar Thrombosis Risk Assessment Scale scores were analyzed. Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors, and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS Univariate analysis showed statistically significant differences (P < 0.05) in age, sex, Karnofsky performance status score (KPS), bedridden time, activities of daily living impairment, parenteral nutrition, catheter duration, distant metastasis, and bone marrow suppression between the thrombosis group and the non-thrombosis group. Other aspects had no statistically significant differences (P > 0.05). Multivariate regression analysis showed that age ≥ 60 years, KPS score ≤ 50 points, parenteral nutrition, stage III to IV, distant metastasis, bone marrow suppression, and activities of daily living impairment were independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer (P < 0.05). Catheter duration of 1-6 months and catheter duration > 6 months were protective factors for PICC-related thrombosis (P < 0.05). The predictive model for PICC-related thrombosis was obtained as follows: P predictive probability = [exp (Logit P )]/[1 + exp (Logit P )], where Logit P = age × 1.907 + KPS score × 2.045 + parenteral nutrition × 9.467 + catheter duration × 0.506 + tumor-node-metastasis (TNM) staging × 2.844 + distant metastasis × 2.065 + bone marrow suppression × 2.082 + activities of daily living impairment × 13.926. ROC curve analysis showed an area under the curve (AUC) of 0.827 (95%CI: 0.724-0.929, P < 0.001), with a corresponding optimal cut-off value of 0.612, sensitivity of 0.755, and specificity of 0.857. Calibration curve analysis showed good consistency between the predicted occurrence of PICC-related thrombosis and actual occurrence (P > 0.05). ROC analysis showed AUCs of 0.888 and 0.729 for the training and validation sets, respectively. CONCLUSION Age, KPS score, parenteral nutrition, TNM staging, distant metastasis, bone marrow suppression, and activities of daily living impairment are independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer, while catheter duration is a protective factor for the disease. The predictive model has an AUC of 0.827, indicating high predictive accuracy and clinical value.

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Section: Discussionmentioning

confidence: 99%

Establishment and validation of a predictive model for peripherally inserted central catheter-related thrombosis in patients with liver cancer

Chen,

Wu,

et al. 2024

World J Gastrointest Surg

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“…The levels of glucose regulatory hormones were then obtained retrospectively from the medical records of the patients. The levels of glucose-related hormones in 15 patients with IGF-II producing NICTH were also reviewed from case reports published in Japan after 2005 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. IGF-II analysis of patients in these case reports was also performed at the authors' institutions.…”

Section: Plasma Glucose and Insulin Levelsmentioning

confidence: 99%

Levels of glucose-regulatory hormones in patients with non-islet cell tumor hypoglycemia: including a review of the literature

et al. 2017

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RECURRENT fasting hypoglycemia occurs in association with certain kinds of tumors other than insulinomas. This paraneoplastic syndrome is classified as non-islet cell tumor hypoglycemia (NICTH) and its incidence is considerably less than hypoglycemia caused by insulinomas. Following a case report of a patient with leiomyosarcoma associated with hypoglycemia who had large molecular weight (big) insulin-like growth factor (IGF)-II detected in both the tumor and the circulation, and the finding of structural and functional similarities between IGF-II and (pro) insulin, overproduction and secretion of big IGF-II Levels of glucose-regulatory hormones in patients with non-islet cell tumor hypoglycemia: including a review of the literature Izumi Fukuda 1) , Akira Asai 1) , Tomoko Nagamine 1) , Taro Harada 1) , Kyoko Tanimura-Inagaki 1) , Naomi Hizuka 2) and Hitoshi Sugihara Abstract. Non-islet cell tumor hypoglycemia (NICTH) is one of the causes of spontaneous hypoglycemia. The pathogenesis of NICTH is thought to be an excessive production by tumors of big insulin-like growth factor (IGF)-II. This study investigated the levels of glucose-regulatory hormones in patients with NICTH with high serum levels of big IGF-II (big IGF-II group) and compared these with profiles of patients with spontaneous hypoglycemia with normal IGF-II (normal IGF-II group). Circulating IRI, CPR, ACTH, cortisol, GH, and IGF-I levels measured during hypoglycemic episodes were examined retrospectively in 37 patients with big IGF-II producing NICTH and 6 hypoglycemic patients with normal IGF-II. The hormone profile data of 15 patients with NICTH from published case reports were reviewed and included in the analyses. Mean plasma glucose levels (36 vs. 29 mg/dL), serum IRI (0.53 vs. 0.37 µIU/mL), CPR (0.15 vs. 0.20 ng/mL), IGF-I SDS (-3.55 vs. -3.18 SD) and ACTH levels (27.3 vs. 33.8 pg/mL) were not significantly different between the big and normal IGF-II groups. However, mean serum GH (0.85 vs. 9.62 ng/mL) and plasma cortisol levels (16.2 vs. 34.5 μg/dL) were significantly lower in the big IGF-II group than in the normal IGF-II group (both p<0.05). In conclusion, although the magnitude of the decrease in insulin and IGF-I levels did not differ between spontaneous hypoglycemic patients caused by other etiologies, patients with NICTH tended to have low basal GH levels during hypoglycemic episodes. These differences in hormone profile may be helpful for selecting patients who require analysis of IGF-II.

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Severe hypoglycemia associated with insulin-like growth factor II-producing liver metastasis from gastric carcinoma treated with overnight total parenteral nutrition via a central vein catheter reserve port

Cited by 2 publications

References 11 publications

Establishment and validation of a predictive model for peripherally inserted central catheter-related thrombosis in patients with liver cancer

Establishment and validation of a predictive model for peripherally inserted central catheter-related thrombosis in patients with liver cancer

Levels of glucose-regulatory hormones in patients with non-islet cell tumor hypoglycemia: including a review of the literature

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