Systemic glucose variability predicts cerebral metabolic distress and mortality after subarachnoid hemorrhage: a retrospective observational study

Kurtz, Pedro; Claassen, Jan; Helbok, Raimund; Schmidt, J. Michael; Fernández, Luís; Presciutti, Mary; Stuart, R. Morgan; Connolly, E. Sander; Lee, Ki-Won; Badjatia, Neeraj; Mayer, Stephan A.

doi:10.1186/cc13857

Cited by 59 publications

(47 citation statements)

References 52 publications

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“…Blood glucose variability, reflected by the standard deviation of blood glucose levels in ICU, has been associated with patient outcomes, including short-term mortality in general critically ill patients [2,48,49], and neurologic outcomes in patients with acute brain injury [50,51]. Reduced mortality with intensive insulin therapy in the Leuven studies could not be attributed to an effect on blood glucose amplitude variation [2].…”

Section: Glucose Variabilitymentioning

confidence: 93%

Critical illness-induced dysglycemia and the brain

et al. 2014

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Section: Glucose Variabilitymentioning

confidence: 93%

Critical illness-induced dysglycemia and the brain

et al. 2014

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“…Several previous studies suggest that the variability in glucose levels over time is an important determinant of mortality among critically ill patients (21,22,58). Alternatively, recent evidence shows that glucose fluctuations may influence the development of diabetic complications(4, 47) and may produce more serious injury in organ functions than sustained high blood glucose.…”

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confidence: 99%

miR-1273g-3p participates in acute glucose fluctuation-induced autophagy, dysfunction, and proliferation attenuation in human umbilical vein endothelial cells

Guo

Sang

Yin

et al. 2016

American Journal of Physiology-Endocrinology and Metabolism

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-Acute glucose fluctuations (AGF) often cause high mortality among critically ill patients, but the mechanisms induced by AGF are not clear. Recent studies suggest that endothelial dysfunction is a key factor that leads to high mortality among critically ill patients. Our goal is to evaluate the phenomenon and mechanisms of endothelial dysfunction induced by AGF. In this study, the functions of human umbilical vein endothelial cells (HUVECs) were compared after treatment with sustained high glucose (SHG), AGF in two groups (AGF1 fluctuations between 5 and 16 mM and AGF2 fluctuations between 5 and 25 mM), and normal glucose levels as a control group (CTR). The medium of the groups was changed every 4 h. The influence of AGF on wound healing was also tested on C57BL/6 mice. The results show that cell proliferation, angiogenesis, and migration functions were injured in the SHG and both AGF groups. AGF2 group shows the worse condition in vitro. In vivo, the wound healing was delayed after the AGF treatment. Furthermore, the markers of apoptosis and autophagy were analyzed. We observed that the autophagy changed in all treatment groups, but apoptosis showed no change. To get to know the mechanism of dysfunction and autophagy, we performed the microRNA chip assay and real-time PCR and found miR-1273g-3p remarkably changed in AGF2 group. After the mimic and inhibitor of miR-1273g-3p were transfected during the AGF2 treatment, we found that the dysfunction and autophagy were partially enhanced by miR-1273g-3p mimic and reversed by miR-1273g-3p inhibitor in AGF2 group. Thus, we conclude that AGF can induce more dysfunction and autophagy, and miR-1273g-3p is also an important factor that leads to the injury. glucose fluctuations; endothelial dysfunction; wound healing; autophagy; miR-1273g-3pINCREASING GLYCEMIC VARIABILITY can greatly increase the risk of mortality among critically ill patients. Several previous studies suggest that the variability in glucose levels over time is an important determinant of mortality among critically ill patients (21,22,58). Alternatively, recent evidence shows that glucose fluctuations may influence the development of diabetic complications(4, 47) and may produce more serious injury in organ functions than sustained high blood glucose. Krinsley and Preiser (20) reported that if a blood glucose range of 70 -140 mg/dl is maintained for Ͼ80% of the time, the chances of survival of nondiabetic critically ill adults will be greatly increased. Organ injury induced by glucose toxicity is commonly observed in both intensive care units and endocrine departments. The damage is also observed in in vitro cell culture and animal studies. Therefore, some authors have proposed that "glycemic variability" is a new therapeutic challenge in diabetes and the critical care setting (7).The mechanism of the production of glucose fluctuations is variable in several studies (35)(36)(37)(38)(39)57) in both preclinical and clinical research studies. However, this is not appropriate for the critically ill patient...

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“…This data is consistent with the view that anemia was among the most frequent complications in the studied patients. In addition, GCS is not an appropriate indicator to evaluate the neurological status in patients admitted to ICU due to paralysis or sedative medication use [14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Complications of Subarachnoid Hemorrhage in Patients Admitted to Imam Khomeini Hospital in Urumia

Azar¹,

Valizadeh²,

Akhondian³

et al. 2018

Iran. J. Neurosurg.

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Background and Aim: Secondary complications management of Subarachnoid Hemorrhage (SAH) is one of the therapeutic challenging issues during Intensive Care Unite (ICU) admission. The complications of patients with SAH admitted to the ICU of Imam Khomeini Hospital of Urumia were investigated in this study. Methods and Materials/Patients:In this descriptive study, the clinical complications of the patients with SAH admitted to ICU including anemia, fever, hyperglycemia, hypertension, electrolyte imbalance, and cardiac arrhythmia were collected from their medical records within a 7-year period. The collected data were analyzed using Chi-squared test and t-test by SPSS. Results:In total, 483 records of patients with SAH were explored. Moreover, 183 (37.9%) samples had anemia, 174 (36%) suffered from fever, 204 (42.2%) patients were diagnosed with hypertension. A total of 111 (23%) patients had hyperglycemia, 54 (11.2%) individuals suffered from sodium disorders. Additionally, 131 (27.1%) individuals had cardiac arrhythmias. Conclusion:The obtained results suggested that the most prevalent complications following SAH are hypertension, anemia and fever. Furthermore, there was a significant correlation between cardiac arrhythmias, as well as sodium and hyperglycemia disorders, and the treatment outcome of patients. Patients admitted to ICU should be under intensive care to reduce the mortality rate associated with SAH.

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Systemic glucose variability predicts cerebral metabolic distress and mortality after subarachnoid hemorrhage: a retrospective observational study

Cited by 59 publications

References 52 publications

Critical illness-induced dysglycemia and the brain

Critical illness-induced dysglycemia and the brain

miR-1273g-3p participates in acute glucose fluctuation-induced autophagy, dysfunction, and proliferation attenuation in human umbilical vein endothelial cells

Complications of Subarachnoid Hemorrhage in Patients Admitted to Imam Khomeini Hospital in Urumia

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