Impact of Glycemic Variability and Hypoglycemia on the Mortality and Length of Hospital Stay among Elderly Patients in Brazil

2020 ◽  
Vol 16 (2) ◽  
pp. 171-180 ◽  
Author(s):  
Danielle Bruginski ◽  
Dalton Bertolin Précoma ◽  
Ary Sabbag ◽  
Marcia Olandowski
Keyword(s):  
Blood Glucose ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Critically Ill ◽  
Glucose Level ◽  
Length Of Hospital Stay ◽  
Glycemic Variability ◽  
Ease Of Use ◽  
Hospitalized Elderly ◽  
Enteral Diet

Background: Glycemic variability (GV) is an alternative diabetes-related parameter that has been associated with mortality and longer hospitalization periods. There is no ideal method for calculating GV. In this study, we used standard deviation and coefficient of variation due to their suitability for this sample and ease of use in daily clinical practice. Objective: This study aimed to investigate the association between GV, hypoglycemia, and the 90-day mortality and length of hospital stay (LOS) among non-critically ill hospitalized elderly patients. Methods: The medical records of 2,237 elderly patients admitted to the Zilda Arns Elderly Hospital over a 2.5-year period were reviewed. Hypoglycemia was defined as a glucose level <70 mg/dL (hypoglycemia alert value) and represented by the proportion of days in which the patient presented with this condition relative to the LOS. The Charlson comorbidity index was used to evaluate prognosis. Data were analyzed using multiple linear and logistic multivariate regression analyses. Results: Adjusted analysis of 687 patients (305 men [44.4%] and 382 women [55.6%], mean age of 77.86±9.25 years) revealed that GV was associated with a longer LOS (p=0.048). Mortality was associated with hypoglycemia (p=0.005) and mean patient-day blood glucose level (p=0.036). Variables such as age (p<0.001), Charlson score (p<0.001), enteral diet (p<0.001), and corticosteroid use (p=0.007) were also independently associated with 90-day mortality. Conclusion: Increased GV during hospitalization is independently associated with a longer LOS and hypoglycemia in non-critically ill elderly patients, while the mean patient-day blood glucose is associated with increased mortality.

Screening for delirium: a means to improved outcome in hospitalized elderly patients

1997 ◽  
Vol 7 (3) ◽  
pp. 235-256 ◽  
Author(s):  
Dominique L Musselman ◽  
Colleen N Hawthorne ◽  
Alan Stoudemire
Keyword(s):  
Nursing Home ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Cognitive Deficits ◽  
Functional Decline ◽  
Length Of Hospital Stay ◽  
Accurate Diagnosis ◽  
Hospitalized Elderly ◽  
Hospitalized Elderly Patients ◽  
Improved Outcome

In recent years, psychiatrists have improved their accuracy and efficiency in diagnosing delirium, particularly in hospitalized elderly patients. Early and accurate diagnosis is essential as unrecognized and untreated delirium is associated with longer length of hospital stay and greater expense, accelerated functional decline, an increase in nursing home placements, persistent cognitive deficits, and elevated rates of mortality.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

scholarly journals Indicadores de variabilidade glicêmica e mortalidade em pacientes críticos com terapia nutricional

2020 ◽  
Vol 34 (4) ◽  
pp. 355-360
Author(s):  
Josiane Monteiro Almeida ◽  
Lucas Lima de Carvalho
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Blood Glucose ◽  
Demographic Data ◽  
Glycemic Variability ◽  
Nutrition Therapy ◽  
Multivariate Logistic Regression Model ◽  
Chi Square ◽  
Glucose Levels ◽  
Enteral Diet

Introduction: Glycemic variability (GV) has been associated with mortality in critically ill patients. Several methods have been used to measure it, but no guideline has so far proposed a gold standard. The aim of this study was to associate different GV measurement methods with mortality in patients in an intensive care unit (ICU) under nutrition therapy (NT). Methods: Retrospective longitudinal study conducted between April and September 2018, in which 82 patients were enrolled in intensive care, with more than 48 hours of hospitalization and using NT. Demographic data, clinical data and all blood glucose values measured during hospitalization were collected. The GV was evaluated through three indicators: standard deviation (SD), coefficient of variation (CV) and glycemic mean (MGL). Statistical analysis was performed using Whitney and Pearson Chi-square tests, univariate and multiple logistic regression, and odds ratio. The analyzes were processed and evaluated using the Statistical Data Analysis software version 12.0. Results: 11,676 blood glucose levels were measured. Most of the sample received enteral diet. Mortality was 42.7%. A total of 36.58% of the patients had a previous diagnosis of diabetes mellitus (DM) and these presented higher values for all evaluated parameters of VG compared to non-diabetics. CV, SD and MGL values were higher among the patients who died. Univariate logistic regression analysis showed that the variables CV, SD and MGL were significantly associated with mortality. However, based on the multivariate logistic regression model, only PD maintained a relationship with mortality. Conclusion: The SD is an indicator of GV is independently associated with increased mortality in a cohort of heterogeneous patients on TN in the ICU.

PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Jeroen Hol ◽  
Joos Heisterkamp ◽  
Barbara Langenhoff
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Tumor Type ◽  
Invasive Esophagectomy ◽  
Group 2 ◽  
Group 1

Abstract Background Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented. Methods Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old. Results From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively. Conclusion No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone. Disclosure All authors have declared no conflicts of interest.

scholarly journals Prospective analysis of glycemic variability in patients with severe traumatic brain injury: modified Leuven’s adjustment process versus conventional adjustment process

2018 ◽  
Vol 46 (4) ◽  
pp. 1505-1516
Author(s):  
Bing Xue ◽  
Shiyan Ruan ◽  
Ping Xie ◽  
Kaixuan Yan ◽  
Zhi'e Gu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Severe Traumatic Brain Injury ◽  
Early Stage ◽  
Glycemic Variability ◽  
Adjustment Process ◽  
Significant Difference

Objective This study was performed to evaluate the effect of two different methods of controlling glycemic variability (GV) in patients with severe traumatic brain injury (STBI) undergoing surgery. Methods Patients with STBI were randomly grouped into a conventional adjustment process (CAP) group and modified Leuven’s adjustment process (mLAP) group. Each group included 50 patients. Blood glucose levels were continuously monitored and data were recorded and analyzed. Results The mean blood glucose level was stable in both groups for 5 days postoperatively with no significant difference. The standard deviation of the blood glucose level, mean amplitude of glycemic excursions, and glycemic lability index were significantly higher in the CAP than mLAP group for the first 2 days. In the final 3 days, no significant differences were observed between the two groups. The incidence of hypoglycemia was significantly higher in the CAP than mLAP group on the first day. This value gradually declined during the following 4 days, but the difference between the two groups was not significant. Conclusion The mLAP produced more favorable results than the CAP for GV control in the early stage after surgery for STBI.

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