Differential Impact of Hyperglycemia in Critically Ill Patients: Significance in Acute Myocardial Infarction but Not in Sepsis?
"> Figure 1
<p>In the overall population severe hyperglycemia (>200 mg/dL) was associated with increased mortality in the long-term (HR 1.74, 95% CI: 1.44–2.09; <span class="html-italic">p</span> < 0.001).</p> "> Figure 2
<p>Patients admitted for sepsis and suffering from severe hyperglycemia did not evidence increased mortality in the long-term (HR 1.13, 95% CI: 0.89–1.44; <span class="html-italic">p</span> = 0.32).</p> "> Figure 3
<p>Myocardial infarction patients with severe hyperglycemia at admission day evidenced a significantly increased mortality in the long-term (HR 2.19, 95% CI: 1.66–2.89; <span class="html-italic">p</span> < 0.001).</p> ">
Abstract
:1. Introduction
2. Results
3. Discussion
4. Methods
4.1. Laboratory Analysis
4.2. Calculation of SAPS2 and APACHE Score
4.3. Statistical Analysis
5. Conclusions
6. Limitations
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Parameter | Overall Cohort | Admitted for Sepsis | Admitted for MI | p-Value |
---|---|---|---|---|
age | 69 (58–77) | 68 (67–76) | 69 (59–77) | 0.18 |
male | 61% | 60% | 62% | 0.42 |
lactate (mmol/L) | 2.69 ± 3.93 | 4.35 ± 4.94 | 2.10 ± 3.31 | <0.001 |
glucose (mg/dL) | 180 ± 72 | 195 ± 67 | 175 ± 73 | <0.001 |
leucocytes (G/L) | 12.43 ± 8.19 | 16.54±14.05 | 11.23±4.74 | <0.001 |
(lowest) pO2 (kPa) | 9.12 ± 2.12 | 5.35 ± 1.00 | 5.63 ± 1.92 | 0.005 |
pCO2 (kPa) | 6.12 ± 1.85 | 6.76 ± 2.33 | 5.66 ± 1.38 | <0.001 |
heart rate (bpm) | 97 ± 23 | 118 ± 23 | 91 ± 20 | <0.001 |
sodium (mmol/L) | 140.02 ± 4.63 | 141.72 ± 7.14 | 139.65 ± 3.76 | <0.001 |
potassium (mmol/L) | 4.20 ± 0.54 | 4.27 ± 0.67 | 4.10 ± 0.50 | <0.001 |
type 2 diabetes | 13% | 13% | 13% | - |
creatinine (µmol/L) | 95 (78–95) | 180 (112–297) | 89 (76–116) | <0.001 |
ALAT (µmol/(l*s)) | 0.7 (0.4–1.3) | 0.7 (0.3–1.4) | 0.7 (0.5–1.2) | 0.007 |
ASAT (µmol/(l*s)) | 1.6 (0.7–4.2) | 1.0 (0.5–2.6) | 2.1 (0.8–4.7) | <0.001 |
APACHE score | 20 ± 10 | 26 ± 8 | 16 ± 8 | <0.001 |
SAPS2 score | 40 ± 20 | 54 ± 20 | 33 ± 16 | <0.001 |
Group | HR | 95% CI | p-Value |
---|---|---|---|
overall cohort | 1.006 | 1.004–1.127 | <0.001 |
admitted for sepsis | 1.03 | 0.998–1.062 | 0.07 |
admitted for AMI | 1.101 | 1.075–1.127 | <0.001 |
Parameter | <200 mg/dL | >200 mg/dL | p-Value |
---|---|---|---|
age | 68 (57–77) | 71 (63–78) | <0.001 |
male | 60% | 64% | 0.04 |
lactate (mmol/L) | 2.42 ± 3.12 | 4.05 ± 5.81 | <0.001 |
glucose (mg/dL) | 143 ± 30 | 267 ± 66 | <0.001 |
leucocytes (G/L) | 12.07 ± 8.49 | 15.10 ± 9.51 | <0.001 |
(lowest) pO2 (kPa) | 5.45 ± 1.44 | 5.26 ± 1.31 | 0.09 |
pCO2 (kPa) | 5.88 ± 1.66 | 6.40 ± 2.16 | <0.001 |
heart rate (bpm) | 98 ± 23 | 107 ± 24 | <0.001 |
sodium (mmol/L) | 139.90 ± 4.41 | 140.67 ± 6.28 | 0.03 |
potassium (mmol/L) | 4.12 ± 0.54 | 4.20 ± 0.64 | 0.07 |
type 2 diabetes | 10% | 25% | <0.001 |
creatinine (µmol/L) | 95 (77–152) | 120 (89–199) | <0.001 |
ALAT (µmol/(l*s)) | 0.7 (0.4–1.3) | 0.8 (0.5–1.5) | <0.001 |
ASAT (µmol/(l*s)) | 1.4 (0.6–4.1) | 1.8 (0.7–5.1) | <0.001 |
APACHE score | 19 ± 9 | 24 ± 10 | <0.001 |
SAPS2 score | 39 ± 20 | 47 ± 20 | <0.001 |
BMI (kg/m2) | 27 ± 4 | 28 ± 5 | <0.001 |
Group | HR | 95% CI | p-Value | Glucose <200 mg/dL | Glucose >200 mg/dL |
---|---|---|---|---|---|
overall cohort | 1.88 | (1.46–2.43) | <0.001 | 13% | 23% |
admitted for sepsis | 1.02 | (0.71–1.47) | 0.48 | 39% | 40% |
admitted for MI | 3.02 | (2.01–4.54) | <0.001 | 5% | 15% |
Parameter | <200 mg/dL | >200 mg/dL | p-Value |
---|---|---|---|
age | 68 (55–76) | 68 (59–77) | 0.21 |
male | 61% | 62% | 0.85 |
lactate (mmol/L) | 4.14 ± 4.76 | 4.75 ± 5.25 | 0.17 |
glucose (mg/dL) | 156 ± 29 | 260 ± 62 | <0.001 |
leucocytes (G/L) | 15.22 ± 13.99 | 18.73 ± 13.95 | 0.006 |
(lowest) pO2 (kPa) | 5.32 ± 0.95 | 5.39 ± 0.99 | 0.55 |
pCO2 (kPa) | 6.60 ± 2.20 | 7.02 ± 2.51 | 0.04 |
heart rate (bpm) | 118 ± 22 | 119 ± 23 | 0.65 |
sodium (mmol/L) | 141.48 ± 6.96 | 142.14 ± 7.44 | 0.43 |
potassium (mmol/L) | 4.27 ± 0.65 | 4.28 ± 0.70 | 0.92 |
type 2 diabetes | 12% | 17% | 0.07 |
creatinine (µmol/L) | 180 (112–292) | 184 (114–317) | 0.46 |
ALAT (µmol/(l*s)) | 0.7 (0.3–1.4) | 0.7 (0.4–1.2) | 0.69 |
ASAT (µmol/(l*s)) | 1.0 (0.4–2.5) | 1.1 (0.5–2.9) | 0.34 |
APACHE score | 26 ± 8 | 28 ± 8 | 0.02 |
SAPS2 score | 53 ± 20 | 55 ± 20 | 0.25 |
Parameter | <200 mg/dL | >200 mg/dL | p-Value |
---|---|---|---|
age | 68 (57–77) | 73 (65–79) | <0.001 |
male | 59% | 65% | 0.03 |
lactate (mmol/L) | 1.82 ± 1.94 | 3.65 ± 6.05 | <0.001 |
glucose (mg/dL) | 139 ± 30 | 272 ± 68 | <0.001 |
leucocytes (G/L) | 11.09 ± 5.23 | 13.22 ± 4.92 | <0.001 |
(lowest) pO2 (kPa) | 5.53 ± 1.71 | 5.12 ± 1.54 | 0.02 |
pCO2 (kPa) | 5.54 ± 1.16 | 5.97 ± 1.76 | <0.001 |
heart rate (bpm) | 92 ± 20 | 101 ± 22 | <0.001 |
sodium (mmol/L) | 139.61 ± 3.65 | 140.04 ± 5.61 | 0.16 |
potassium (mmol/L) | 4.11 ± 0.51 | 4.17 ± 0.61 | 0.12 |
type 2 diabetes | 10% | 29% | <0.001 |
Creatinine (µmol/L) | 88 (75–114) | 107 (86–155) | <0.001 |
ALAT (µmol/(l*s)) | 0.7 (0.4–1.3) | 1.0 (0.58–1.6) | <0.001 |
ASAT (µmol/(l*s)) | 2.0 (0.7–4.9) | 2.9 (1.1–6.2) | <0.001 |
APACHE score | 16 ± 8 | 21 ± 8 | <0.001 |
SAPS2 score | 32 ± 16 | 41 ± 18 | <0.001 |
BMI (kg/m2) | 28 ± 4 | 29 ± 5 | 0.001 |
Parameter | No T2DM | T2DM | p-Value |
---|---|---|---|
age | 68 (57–76) | 72 (65–78) | <0.001 |
male | 61% | 61% | 0.9 |
lactate (mmol/L) | 2.59 ± 3.17 | 3.27 ± 6.88 | 0.10 |
glucose (mg/dL) | 175 ± 70 | 213 ± 76 | <0.001 |
leucocytes (G/L) | 12.43 ± 8.44 | 12.43 ± 6.46 | 0.99 |
(lowest) pO2 (kPa) | 5.53 ± 1.68 | 5.46 ± 1.36 | 0.64 |
pCO2 (kPa) | 6.02 ± 1.74 | 6.27 ± 2.38 | 0.06 |
heart rate (bpm) | 97 ± 23 | 99 ± 24 | 0.23 |
sodium (mmol/L) | 140.01 ± 4.55 | 14.10 ± 5.13 | 0.80 |
potassium (mmol/L) | 4.13 ± 0.54 | 4.14 ± 0.54 | 0.65 |
BMI | 28 ± 5 | 29 ± 4 | <0.001 |
creatinine (µmol/L) | 93 (77–146) | 108 (86–174) | <0.001 |
ALAT (µmol/(l*s)) | 0.7 (0.4–1.3) | 0.7 (0.4–1.2) | 0.70 |
ASAT (µmol/(l*s)) | 1.7 (0.7–4.2) | 1.4 (0.7–4.2) | 0.85 |
APACHE score | 20 ± 10 | 22 ± 10 | 0.02 |
SAPS2 score | 40 ± 20 | 43 ± 21 | 0.06 |
intra-ICU survival | 15% | 15% | 0.93 |
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Wernly, B.; Lichtenauer, M.; Franz, M.; Kabisch, B.; Muessig, J.; Masyuk, M.; Kelm, M.; Hoppe, U.C.; Jung, C. Differential Impact of Hyperglycemia in Critically Ill Patients: Significance in Acute Myocardial Infarction but Not in Sepsis? Int. J. Mol. Sci. 2016, 17, 1586. https://doi.org/10.3390/ijms17091586
Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig J, Masyuk M, Kelm M, Hoppe UC, Jung C. Differential Impact of Hyperglycemia in Critically Ill Patients: Significance in Acute Myocardial Infarction but Not in Sepsis? International Journal of Molecular Sciences. 2016; 17(9):1586. https://doi.org/10.3390/ijms17091586
Chicago/Turabian StyleWernly, Bernhard, Michael Lichtenauer, Marcus Franz, Bjoern Kabisch, Johanna Muessig, Maryna Masyuk, Malte Kelm, Uta C. Hoppe, and Christian Jung. 2016. "Differential Impact of Hyperglycemia in Critically Ill Patients: Significance in Acute Myocardial Infarction but Not in Sepsis?" International Journal of Molecular Sciences 17, no. 9: 1586. https://doi.org/10.3390/ijms17091586