Optimal Glycemic Control for Patients with Pancreatitis in the Intensive Care Unit: A Retrospective Study Based on a Large Intensive Care Unit Database
Objectives: Stress hyperglycemia is a common complication of pancreatitis. This study aimed to determine optimal blood glucose control goals for patients with pancreatitis. Methods: We conducted a screening of adult patients diagnosed with pancreatitis who were admitted to the ICU using data from the Medical Information Marketplace for Intensive Care IV (MIMIC-IV) database. In total, 574 cases were enrolled in this study and were divided into four groups based on blood glucose levels. We investigated the effects of four groups on the prognosis of patients with pancreatitis. Results: The survival group exhibited lower Glu_mean and Glu_cv values, but there was no significant effect on mortality. Glu_cv and frequency of daily blood glucose monitoring were significantly correlated with length of hospital stay, but had no significant effect on length of ICU stay. Subgroup analysis showed that the mortality rate was the highest when the mean blood glucose was 7.8 - 10.0 mmol/L, and the lowest when Glu_mean was 6.1 - 7.8 mmol/L.
References
[1]
Cappell, M.S. (2008) Acute Pancreatitis: Etiology, Clinical Presentation, Diagnosis, and Therapy. Medical Clinics of North America, 92, 889-923. https://doi.org/10.1016/j.mcna.2008.04.013
[2]
Whitcomb, B.W., Pradhan, E.K., Pittas, A.G., Roghmann, M.C. and Perencevich, E.N. (2005) Impact of Admission Hyperglycemia on Hospital Mortality in Various Intensive Care Unit Populations. Critical Care Medicine, 33, 2772-2777. https://doi.org/10.1097/01.CCM.0000189741.44071.25
[3]
Wu, Z., Liu, J., Zhang, D., Kang, K., Zuo, X., Xu, Q., Pan, A., Fang, W., Liu, F., Shang, Y., et al. (2022) Expert Consensus on the Glycemic Management of Critically Ill Patients. Journal of Intensive Medicine, 2, 131-145. https://doi.org/10.1016/j.jointm.2022.06.001
[4]
McDonnell, M.E. and Umpierrez, G.E. (2012) Insulin Therapy for the Management of Hyperglycemia in Hospitalized Patients. Endocrinology and Metabolism Clinics of North America, 41, 175-201. https://doi.org/10.1016/j.ecl.2012.01.001
[5]
Becker, C.D., Sabang, R.L., Nogueira, C.M., Hassan, I.F., Goldberg, M.D. and Scurlock, C.S. (2020) Hyperglycemia in Medically Critically Ill Patients: Risk Factors and Clinical Outcomes. The American Journal of Medicine, 133, e568-e574. https://doi.org/10.1016/j.amjmed.2020.03.012
[6]
Gokhale, V., Batra, T., Shinde, S.S., Gulati, S. and Kakrani, A.L. (2019) Glucose Monitoring in Critically Ill: Is Absence of “Stress Hyperglycemia” a Cause for Concern? JAPI: Journal of the Association of Physicians of India, 67, 43-46.
[7]
Kwan, T.N., Zwakman-Hessels, L., Marhoon, N., Robbins, R., Martensson, J., Ekinci, E. and Bellomo, R. (2020) Relative Hypoglycemia in Diabetic Patients with Critical Illness. Critical Care Medicine, 48, e233-e240. https://doi.org/10.1097/CCM.0000000000004213
[8]
Capes, S.E., Hunt, D., Malmberg, K. and Gerstein, H.C. (2000) Stress Hyperglycaemia and Increased Risk of Death after Myocardial Infarction in Patients with and without Diabetes: A Systematic Overview. The Lancet, 355, 773-778. https://doi.org/10.1016/S0140-6736(99)08415-9
[9]
van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninckx, F., Schetz, M., Vlasselaers, D., Ferdinande, P., Lauwers, P. and Bouillon, R. (2001) Intensive Insulin Therapy in Critically Ill Patients. The New England Journal of Medicine, 345, 1359-1367. https://doi.org/10.1056/NEJMoa011300
[10]
Krinsley, J.S., Egi, M., Kiss, A., Devendra, A.N., Schuetz, P., Maurer, P.M., et al. (2013) Diabetic Status and the Relation of the Three Domains of Glycemic Control to Mortality in Critically Ill Patients: An International Multicenter Cohort Study. Critical Care, 17, R37. https://doi.org/10.1186/cc12547
[11]
Dauphine, C., Kovar, J., Stabile, B.E., Haukoos, J.S. and de Virgilio, C. (2004) Identification of Admission Values Predictive of Complicated Acute Alcoholic Pancreatitis. The Archives of Surgery, 139, 978-982. https://doi.org/10.1001/archsurg.139.9.978
[12]
Mentula, P., Kylän-pää, M.-L., Kemppainen, E., et al. (2005) Early Prediction of Organ Failure by Combined Markers in Patients with Acute Pancreatitis. British Journal of Surgery, 92, 68-75. https://doi.org/10.1002/bjs.4786
[13]
Zuo, Y., Kang, Y., Yin, W., Wang, B. and Chen, Y. (2012) The Association of Mean Glucose Level and Glucose Variability with Intensive Care Unit Mortality in Patients with Severe Acute Pancreatitis. Journal of Critical Care, 27, 146-152. https://doi.org/10.1016/j.jcrc.2011.12.004
[14]
Pinto, D.S., Kirtane, A.J., Pride, Y.B., Murphy, S.A., Sabatine, M.S., Cannon, C.P. and Gibson, C.M. (2008) Association of Blood Glucose with Angiographic and Clinical Outcomes among Patients with ST-Segment Elevation Myocardial Infarction (from the CLARITY-TIMI-28 Study). American Journal of Cardiology, 101, 303-307. https://doi.org/10.1016/j.amjcard.2007.08.034
[15]
Bagshaw, S.M., Egi, M., George, C. and Bellomo, R. (2009) Early Blood Glucose Control and Mortality in Critically Ill Patients in Australia. Critical Care Medicine, 37, 463-470. https://doi.org/10.1097/CCM.0b013e318194b097
[16]
Kosiborod, M., Inzucchi, S.E., Krumholz, H.M., Xiao, L., Jones, P.G., Fiske, S., et al. (2008) Glucometrics in Patients Hospitalized with Acute Myocardial Infarction: Defining the Optimal Outcomes-Based Measure of Risk. Circulation, 117, 1018-1027. https://doi.org/10.1161/CIRCULATIONAHA.107.740498
[17]
Lu, Y., Zhang, Q. and Lou, J. (2021) Blood Glucose-Related Indicators Are Associated with In-Hospital Mortality in Critically Ill Patients with Acute Pancreatitis. Scientific Reports, 11, Article No. 15351. https://doi.org/10.1038/s41598-021-94697-1
[18]
Krinsley, J.S., Meyfroidt, G., van den Berghe, G., Egi, M. and Bellomo, R. (2012) The Impact of Premorbid Diabetic Status on the Relationship between the Three Domains of Glycemic Control and Mortality in Critically Ill Patients. Current Opinion in Clinical Nutrition and Metabolic Care, 15, 151-160. https://doi.org/10.1097/MCO.0b013e32834f0009
[19]
Sechterberger, M.K., Bosman, R.J., Oudemansvan, S.H., Siegelaar, S.E., Hermanides, J., Hoekstra, J.B. and De Vries, J.H. (2013) The Effect of Diabetes Mellitus on the Association between Measures of Glycaemic Control and ICU Mortality: A Retrospective Cohort Study. Critical Care, 17, R52. https://doi.org/10.1186/cc12572
[20]
Richardson, A. and Park, W.G. (2021) Acute Pancreatitis and Diabetes Mellitus: A Review. The Korean Journal of Internal Medicine, 36, 15-24. https://doi.org/10.3904/kjim.2020.505
[21]
Hart, P.A., Bellin, M.D., Andersen, D.K., Bradley, D., Cruz-Monserrate, Z., Forsmark, C.E., et al. (2016) Type 3c (Pancreatogenic) Diabetes Mellitus Secondary to Chronic Pancreatitis and Pancreatic Cancer. The Lancet Gastroenterology & Hepatology, 1, 226-237. https://doi.org/10.1016/S2468-1253(16)30106-6
