Stress hyperglycemia may not be harmful in critically ill patients with sepsis

Tiruvoipati, Ravindranath; Chiezey, Belchi; Lewis, David; Ong, Kevin; Villanueva, Elmer Virgil; Haji, Kavi; Botha, John

doi:10.1016/j.jcrc.2011.06.011

Cited by 53 publications

(35 citation statements)

References 22 publications

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“…An increase in glucose can be attributed to stress conditions. This phenomenon is in compliance with searched literature (Tiruvoipati et al 2011). Hyperglycaemia and glycosuria were also reported to be pathological consequences of accidental exposure to organophosphorus and carbamate pesticides (Shobha and Prakash 2000).…”

Section: Discussionsupporting

confidence: 86%

Acute poisoning with sarin causes alteration in oxidative homeostasis and biochemical markers in Wistar rats

Pohanka

Románek

Pikula

2012

JAB

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Sarin is a potent inhibitor of acetylcholinesterase (AChE). It is known as an agent of chemical warfare and is one of a number of nerve agents misused for chemical terrorism, e.g. on the Tokyo subway attacks. Though effect of sarin on the cholinergic system is well-known, long-term adverse effects and the role of oxidative stress in sarin toxicity remain unknown. The experiment reported here was carried out on laboratory Wistar rats intramuscularly exposed to 0.5-50% of sarin LD 50 for one hour. A complex biochemical examination of plasma samples and an assessment of oxidative stress in the liver, kidney, spleen, cerebellum and frontal lobe were performed after euthanasia of the animals. By means of these biochemical markers, we were able to observe the induction of hyperglycaemia in a dose-dependent manner. Other biochemical markers such as transaminases were influenced in a non-standard manner as sarin probably acted as an inhibitor of these markers. Oxidative stress markers and an assessment of AChE activity showed an unequal impact of sarin on different tissues. Significant inhibition of AChE was found in the cerebellum and frontal lobe. Besides this, alterations in reduced glutathione, ferric reducing antioxidant power (FRAP) and thiobarbituric acid reactive substances (TBARS) were proven. In particular, an accumulation occurred of reduced glutathione in the frontal lobe, whereas depletion of FRAP was found in the kidney and spleen, and a strong increase in TBARS occurred in the spleen in a dose-dependent manner. We infer that sarin extensively influences oxidative homeostasis. Surprisingly, the central nervous system seems to be more resistant than the other organs.

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Section: Discussionsupporting

confidence: 86%

Acute poisoning with sarin causes alteration in oxidative homeostasis and biochemical markers in Wistar rats

Pohanka

Románek

Pikula

2012

JAB

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“…In septic patients, hyperglycemia up to a certain degree is even considered to be beneficial, as increased levels of blood glucose concentration might be a way to ensure sufficient supply of glucose to peripheral cells in case of hypoperfusion [6, 7]. On the other hand, hyperglycemia, especially severe hyperglycemia defined as blood glucose concentration > 200 mg/dL, was reported to be associated with adverse outcome and considered as a bad prognostic marker in various diseases, e.g., sepsis, acute myocardial infarction (AMI), and pulmonary embolism [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia but Not Hyperglycemia Is Associated with Mortality in Critically Ill Patients with Diabetes

et al. 2018

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Background: Both severe hyperglycemia (> 200 mg/dL) and hypoglycemia (≤70 mg/dL) are known to be associated with increased mortality in critically ill patients. Therefore, we investigated associations of a single episode of blood glucose deviation (concentration either ≤70 mg/dL and/or > 200 mg/dL) during an intensive care unit (ICU) stay with mortality in these patients. Methods: A total of 4,986 patients (age 65 ± 15 years; 39% female; 14% type 2 diabetes [T2DM] based on medical records) admitted to a German ICU in a tertiary care hospital were investigated retrospectively. The intra-ICU and long-term mortality of patients between 4 and 7 years after their ICU submission were assessed. Results: A total 62,659 glucose measurements were analyzed. A single glucose deviation was associated with adverse outcomes compared to patients without a glucose deviation, represented by both intra-ICU mortality (22 vs. 10%; OR 2.62; 95% CI 2.23–3.09; p < 0.001) and long-term mortality (HR 2.01; 95% CI 1.81–2.24; p < 0.001). In patients suffering from T2DM hypoglycemia (30 vs. 13%; OR 2.94; 95% CI 2.28–3.80; p < 0.001) but not hyperglycemia (16 vs. 14%; OR 1.05; 95% CI 0.68–1.62; p = 0.84) was associated with mortality. Conclusion: In patients with diabetes, hypo- but not hyperglycemia was associated with increased mortality, whereas in patients without diabetes, both hyper- and hypoglycemia were associated with adverse outcome. Blood glucose concentration might need differential approaches depending on concomitant diseases.

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“…Nonetheless, there are discordant findings on the correlation between hyperglycemia and adverse outcomes in acutely ill patients with or without preexisting diabetes678.…”

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confidence: 99%

An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction

Lin

Lee

et al. 2016

Sci Rep

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Acute hyperglycemia is a frequent finding in patients presenting to the emergency department (ED) with acute myocardial infarction (AMI). The prognostic role of hyperglycemia in diabetic patients with AMI remains controversial. We retrospectively reviewed patients’ medical records to obtain demographic data, clinical presentation, major adverse cardiac events (MACEs), several clinical scores and laboratory data, including the plasma glucose level at initial presentation and HbA1c levels. The glycemic gap, which represents changes in serum glucose levels during the index event, was calculated from the glucose level upon ED admission minus the HbA1c-derived average glucose (ADAG). We enrolled 331 patients after the review of medical records. An elevated glycemic gap between admission serum glucose levels and ADAG were associated with an increased risk of mortality in patients. The glycemic gap showed superior discriminative power regarding the development of MACEs when compared with the admission glucose level. The calculation of the glycemic gap may increase the discriminative powers of established clinical scoring systems in diabetic patients presenting to the ED with AMI. In conclusion, the glycemic gap could be used as an adjunct parameter to assess the severity and prognosis of diabetic patients presenting with AMI. However, the usefulness of the glycemic gap should be further explored in prospective longitudinal studies.

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Stress hyperglycemia may not be harmful in critically ill patients with sepsis

Cited by 53 publications

References 22 publications

Acute poisoning with sarin causes alteration in oxidative homeostasis and biochemical markers in Wistar rats

Acute poisoning with sarin causes alteration in oxidative homeostasis and biochemical markers in Wistar rats

Hypoglycemia but Not Hyperglycemia Is Associated with Mortality in Critically Ill Patients with Diabetes

An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction

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