Prognostic and assessment value of hyperglycemia and glycosylated hemoglobin in critical patients.

Hyperglycemia is common in critical patients and high blood glucose levels have a negative effect on their prognosis. The aim of this study was to investigate the effect of hyperglycemia and glycosylated hemoglobin (GHb) in critical patients. A total of 648 critical patients were enrolled in the study and received a random blood glucose test when they entered the emergency department. If blood glucose was more than 11.1 mM, a GHb test was followed within 24 h. All patients were followed up for 28 days. According to diabetes mellitus (DM) history, GHb value, and outcome of follow-up, patients were divided into different groups, and mortality rates were calculated, respectively. Hyperglycemia was found in 67.44% (437/648) of patients, and 51.49% (225/437) and 48.51% (212/437) had normal and elevated GHb levels, respectively. At the end of the follow-up period, 14 of the normal GHb patients and 32 of the elevated GHb patients died (6.22 and 15.09%, respectively). In the normal GHb group, 53 had a DM history, 23 were newly diagnosed with DM, and 149 had hospital-related hyperglycemia (HRH); the mortality rates were 11.32% (6/53), 8.70% (2/23), and 4.03% (6/149), respectively. In the elevated GHb group, 114 had a DM history, 83 were newly diagnosed with DM, and 15 had HRH; the mortality rates were 13.16% (15/114), 19.27% (16/83), and 6.67% (1/15), respectively. Hyperglycemia and GHb might play important roles in the prognosis and assessment for critical patients, and the prognosis would vary according to the different causes of hyperglycemia.

[1]  Yoshikura Haraguchi,et al.  Close relationship between strict blood glucose control, including suppression of blood glucose variability, and mortality reduction in acutely ill patients with glucose intolerance investigated by means of a bedside-type artificial pancreas , 2010, Journal of Artificial Organs.

[2]  T. Matsushita,et al.  Relationship between hyperglycemia and coronary vascular resistance in non-diabetic patients. , 2010, International journal of cardiology.

[3]  S. Momomura,et al.  Impact of acute hyperglycemia during primary stent implantation in patients with ST-elevation myocardial infarction. , 2009, Journal of cardiology.

[4]  L. Leonidou,et al.  Cytokine production and hospital mortality in patients with sepsis-induced stress hyperglycemia. , 2007, The Journal of infection.

[5]  L. Kuller,et al.  Diabetes, Hyperglycemia, and Inflammation in Older Individuals , 2006, Diabetes Care.

[6]  T. Larson,et al.  New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation. , 2005, Kidney international.

[7]  K. Kimura.  [Biological effects of proinsulin C-peptide]. , 2005, Seikagaku. The Journal of Japanese Biochemical Society.

[8]  Neil R. Powe,et al.  Meta-Analysis: Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus , 2004, Annals of Internal Medicine.

[9]  B. Hagman,et al.  CRF-receptor 1 blockade attenuates acute posttraumatic hyperglycemia in rats. , 2004, The Journal of surgical research.

[10]  M. Demircin,et al.  Perioperative hyperglycemia is a strong correlate of postoperative infection in type II diabetic patients after coronary artery bypass grafting. , 2002, Endocrine journal.

[11]  R. Grimble.  Inflammatory status and insulin resistance , 2002, Current opinion in clinical nutrition and metabolic care.

[12]  A. Marette.  Mediators of cytokine-induced insulin resistance in obesity and other inflammatory settings , 2002, Current opinion in clinical nutrition and metabolic care.

[13]  A. Hamsten,et al.  Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study , 2002, The Lancet.

[14]  A. Kitabchi,et al.  Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. , 2002, The Journal of clinical endocrinology and metabolism.

[15]  G. V. Berghe,et al.  Intensive insulin therapy in critically ill patients. , 2001, The New England journal of medicine.

[16]  J. Cornel,et al.  Impaired glucose metabolism predicts mortality after a myocardial infarction. , 2001, International journal of cardiology.

[17]  H. Gerstein,et al.  Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview , 2000, The Lancet.

[18]  M. Mcmahon,et al.  Host defenses and susceptibility to infection in patients with diabetes mellitus. , 1995, Infectious disease clinics of North America.

[19]  W. Knaus,et al.  APACHE II: a severity of disease classification system. , 1985 .

[20]  C. Higgins,et al.  Leukocyte ABCA1 gene expression is associated with fasting glucose concentration in normoglycemic men. , 2004, Metabolism: clinical and experimental.

[21]  A. Malhotra,et al.  Stress-induced hyperglycemia. , 2001, Critical care clinics.