Relative Hyperglycemia, a Marker of Critical Illness: Introducing the Stress Hyperglycemia Ratio

被引:337
作者
Roberts, Gregory W. [1 ,2 ]
Quinn, Stephen J. [2 ]
Valentine, Nyoli [3 ,4 ]
Alhawassi, Tariq [5 ]
O'Dea, Hazel [6 ]
Stranks, Stephen N. [2 ]
Burt, Morton G. [2 ,7 ,8 ]
Doogue, Matthew P. [4 ,7 ,8 ,9 ]
机构
[1] Flinders Med Ctr, Dept Pharm, Bedford Pk, SA 5042, Australia
[2] Flinders Univ S Australia, Sch Med, Bedford Pk, SA 5041, Australia
[3] Sturt Fleurieu Gen Practice Educ & Training, Adelaide, SA 5061, Australia
[4] Flinders Univ S Australia, Discipline Clin Pharmacol, Bedford Pk, SA 5041, Australia
[5] King Saud Univ, Dept Clin Pharm, Coll Pharm, Riyadh, Saudi Arabia
[6] Flinders Univ S Australia, Sch Nursing, Bedford Pk, SA 5041, Australia
[7] Repatriat Gen Hosp, Southern Adelaide Diabet Serv, Daw Pk, SA 5041, Australia
[8] Repatriat Gen Hosp, Southern Adelaide Endocrine Serv, Daw Pk, SA 5041, Australia
[9] Univ Otago, Dept Med, Christhcurch 8140, New Zealand
关键词
IN-HOSPITAL MORTALITY; ACUTE MYOCARDIAL-INFARCTION; ILL PATIENTS; NONDIABETIC PATIENTS; GLYCATED HEMOGLOBIN; OXIDATIVE STRESS; GLUCOSE CONTROL; INCREASED RISK; MEAN GLUCOSE; ADMISSION;
D O I
10.1210/jc.2015-2660
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Hyperglycemia in hospitalized patients is associated with increased morbidity and mortality. Objective: We examined whether critical illness is more strongly associated with relative or absolute hyperglycemia. Design: The study was an observational cohort study. Patients and Setting: A total of 2290 patients acutely admitted to a tertiary hospital. Main Outcome Measure: The relative hyperglycemia (stress hyperglycemia ratio [SHR]) was defined as admission glucose divided by estimated average glucose derived from glycosylated hemoglobin. The relationships between glucose and SHR with critical illness (in-hospital death or critical care) were examined. Results: In univariable analyses, SHR (odds ratio, 1.23 per 0.1 increment [95% confidence interval, 1.18-1.28]; P < .001) and glucose (odds ratio, 1.18 per mmol/L [1.13-1.23]; P < .001) were associated with critical illness. In multivariable analysis, the association was maintained for SHR (odds ratio, 1.20 per 0.1 increment [1.13-1.28]; P < .001), but not glucose (odds ratio, 1.03 per mmol/L [0.97-1.11]; P = .31). Background hyperglycemia affected the relationship between glucose (P = .002) and critical illness, but not SHR (P = .35) and critical illness. In patients with admission glucose <= 10 mmol/L, the odds ratio for critical illness was higher in the fourth (2.4 [1.4-4.2]; P = .001) and fifth (3.9 [2.3-6.8]; P < .001) SHR quintiles than in the lowest SHR quintile. Conclusions: SHR controls for background glycemia and is a better biomarker of critical illness than absolute hyperglycemia. SHR identifies patients with relative hyperglycemia at risk of critical illness. Future studies should explore whether basing glucose-lowering therapy on relative, rather than absolute, hyperglycemia improves outcomes in hospitalized patients.
引用
收藏
页码:4490 / 4497
页数:8
相关论文
共 35 条
[1]   Standards of Medical Care in Diabetes-2014 [J].
不详 .
DIABETES CARE, 2014, 37 :S14-S80
[2]  
[Anonymous], BMJ
[3]   Inadequate blood glucose control is associated with in-hospital mortality and morbidity in diabetic and nondiabetic patients undergoing cardiac surgery [J].
Ascione, R. ;
Rogers, C. A. ;
Rajakaruna, C. ;
Angelini, G. D. .
CIRCULATION, 2008, 118 (02) :113-123
[4]   Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease [J].
Baker, EH ;
Janaway, CH ;
Philips, BJ ;
Brennan, AL ;
Baines, DL ;
Wood, DM ;
Jones, PW .
THORAX, 2006, 61 (04) :284-289
[5]   Admission blood glucose level and mortality among hospitalized nondiabetic patients with heart failure [J].
Barsheshet, Alon ;
Garty, Moshe ;
Grossman, Ehud ;
Sandach, Amir ;
Lewis, Basil S. ;
Gottlieb, Shmuel ;
Shotan, Abraham ;
Behar, Solomon ;
Caspi, Avi ;
Schwartz, Roseline ;
Tenenbaum, Alexander ;
Leor, Jonathan .
ARCHIVES OF INTERNAL MEDICINE, 2006, 166 (15) :1613-1619
[6]   Through the eyes of the A1C: A call to re-examine stress hyperglycemia [J].
Braithwaite, Susan S. .
CRITICAL CARE MEDICINE, 2010, 38 (02) :717-719
[7]   Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview [J].
Capes, SE ;
Hunt, D ;
Malmberg, K ;
Gerstein, HC .
LANCET, 2000, 355 (9206) :773-778
[8]   Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients - A systematic overview [J].
Capes, SE ;
Hunt, D ;
Malmberg, K ;
Pathak, P ;
Gerstein, HC .
STROKE, 2001, 32 (10) :2426-2432
[9]   Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients [J].
Ceriello, Antonio ;
Esposito, Katherine ;
Piconi, Ludovica ;
Ihnat, Michael A. ;
Thorpe, Jessica E. ;
Testa, Roberto ;
Boemi, Massimo ;
Giugliano, Dario .
DIABETES, 2008, 57 (05) :1349-1354
[10]   Stress-Induced Hyperglycemia After Hip Fracture and the Increased Risk of Acute Myocardial Infarction in Nondiabetic Patients [J].
Chen, Yan ;
Yang, Xincun ;
Meng, Kang ;
Zeng, Zechun ;
Ma, Baotong ;
Liu, Xingpeng ;
Qi, Baoqing ;
Cui, Shuangshuang ;
Cao, Peihong ;
Yang, Yan .
DIABETES CARE, 2013, 36 (10) :3328-3332