Association of Stress Hyperglycemia Ratio With Acute Ischemic Stroke Outcomes Post-thrombolysis

Background and Purpose: The association between stress hyperglycemia and clinical outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) is uncertain. We sought to analyze the association between the stress hyperglycemia ratio (SHR) using different definitions and clinical outcomes in acute patients with ischemic stroke undergoing IVT.Methods: A total of 341 patients with ischemic stroke receiving IVT were prospectively enrolled in this study. The SHR was evaluated using different equations: SHR1, fasting glucose (mmol/L)/glycated hemoglobin (HbA1c) (%); SHR2, fasting glucose (mmol/L)/[(1.59 × HbA1c)−2.59]; SHR3, admission blood glucose (mmol/L)/[(1.59 × HbA1c)−2.59]. A poor functional outcome was defined as a modified Rankin scale score of 3–6 at 3 months. Multivariate logistic regression analysis was used to identify the relationship between different SHRs and clinical outcomes after IVT.Results: A total of 127 (37.2%) patients presented with poor functional outcomes at 3 months. The predictive value of SHR1 for poor functional outcomes was better than that of SHR2 and SHR3 in receiver operating characteristic analyses. On multivariate analysis, SHR1 [odds ratio (OR) 14.639, 95% CI, 4.075–52.589; P = 0.000] and SHR2 (OR, 19.700; 95% CI; 4.475–86.722; P = 0.000) were independently associated with an increased risk of poor functional outcome but not SHR3.Conclusions: Our study confirmed that the SHR, as measured by SHR1 and SHR2, is independently associated with worse clinical outcomes in patients with ischemic stroke after intravenous thrombolysis. Furthermore, SHR1 has a better predictive performance for outcomes than other SHR definitions.

Stress Hyperglycemia: A Problem that Cannot be Ignored

Stress hyperglycemia is a strong neuroendocrine reaction in thehypothalamic pituitary adrenal cortex under severe infection, trauma, burns,hemorrhage, surgery and other harmful stimulated, resulting in increasedsecretion of counter-regulatory hormones. These hormones promotedthe production of sugar and cause glucose metabolism disorders withcytokines and insulin resistance. In this condition, the production of sugarexceeds the utilization of sugar by the tissues, which eventually leads to anincrease in blood glucose levels in plasma. In the intensive care unit, stresshyperglycemia is very common and can occur in patients with or withoutdiabetes. The incidence is as high as 96%, and it is an independent factorin the death of critically ill patients. Hyperglycemia not only prolongsthe hospitalization time, mechanical ventilation time and increased theincidence of serious infections in critically ill patients, but can also leadto the occurrence of type 2 diabetes. Therefore, it is very important tolearn the pathological mechanism of stress hyperglycemia, the harm ofhyperglycemia and blood sugar management.

Association of Stress hyperglycemia and adverse cardiac events in acute myocardial infarction – A cohort study

Background: Stress hyperglycemia is a common phenomenon in patients presenting with acute myocardial infarction (MI). We aim to evaluate the association of stress hyperglycemia at the time of hospital presentation and adverse cardiac events in myocardial infarction during the course of hospital stay. Methods: Subjects with age ≥18 years with acute MI were recruited on hospital admission and categorized based on admission blood glucose (<180 and ≥180 mg/dl, 50 patients in each group). Both groups were compared for clinical outcomes, adverse cardiac events and mortality. We also compared the adverse cardiac outcomes based on HbA1c levels (<6% and ≥6%). Results: Patients with high blood glucose on admission (stress hyperglycemia) had significant increased incidences of severe heart failure (Killip class 3 and 4), arrythmias, cardiogenic shock and mortality (p value = 0.001, 0.004, 0.044, and 0.008 respectively). There was no significant association between adverse cardiac events and HbA1c levels (heart failure 18.8% vs. 25%, p value = 0.609 and mortality 16.7% vs. 17.3%, p value = 0.856). Conclusions: Stress hyperglycemia is significantly associated with adverse clinical outcomes in patients with MI irrespective of previous diabetic history or glycemic control. Clinicians should be vigilant for admission blood glucose while treating MI patients.

Plasma low molecular weight aminothiols in ischemic stroke patients with type 2 diabetes mellitus

It was found that ischemic stroke (IS) results in decreased levels of a number of reduced forms of low molecular weight aminothiols (LMWTs). The study was aimed to assess the impact of type 2 diabetes mellitus (Т2D) on the total content, reduced forms and redox status of LMWTs in patients with IS. A total of 175 patients with IS in the internal carotid artery basin (the average age was 62 (55–69)) years) were assessed, who were admitted to the Center within the first 10–24 h since the onset of neurological disorder. The index group included 68 patients with IS and T2D (males made up 41.2%). The comparison group consisted of 107 patients with IS and stress hyperglycemia (males made up 57%), and the control group included 31 non-diabetic patients with chronic cerebrovascular disease (CCVD) (males made up 54.8%). The admission plasma levels of LMWTs were assessed by liquid chromatography in all patients. It was found, that IS in patients with T2D was associated with the rapid decrease in total cysteine (tCys), total glutathione (tGSH), total homocysteine (tHcy), reduced glutathione (rGSH), and glutathione redox status (GSH RS), along with the increase in cysteine redox status (Cys RS) and homocysteine redox status (Hcy RS). In contrast to patients with stress hyperglycemia developing during the acute period of IS, patients with T2D had lower tCys, tGSH, and tHcy levels. Thus, GSH RS of 4.06% or lower in the first 24 hours after the IS in patients with T2D was a predictor of poor functional outcome (mRS score was 3 or more 3 weeks after IS).

Η γλυκοζυλιωμένη αιμοσφαιρίνη και ο αριθμός των ηωσινοφίλων του περιφερικού αίματος ως δείκτες πρόγνωσης και βαρύτητας της παρόξυνσης της χρόνιας αποφρακτικής πνευμονοπάθειας

Εισαγωγή: Κοινός παρονομαστής μεταξύ Χρόνιας Αποφρακτικής Πνευμονοπάθειας και Σαχκαρώδους Διαβήτη ΙΙ είναι η συστηματική φλεγμονή που εξηγεί την αλληλοσυσχέτιση στην ανάπτυξη και εξέλιξη αυτών. Η προοπτική αυτή μελέτη παρατήρησης εξέτασε την προγνωστική αξία της HbA1c και των σχετιζόμενων μεταβλητών (glycemic gap, stress hyperglycemia ratio και modified stress hyperglycemia ratio) στην εισαγωγή για παρόξυνση ΧΑΠ όσον αφορά τη νοσηρότητα και θνητότητα της παρόξυνσης αλλά και της νόσου εντός του επόμενου έτους. Υλικό και Μέθοδοι: Μελετήθηκαν ασθενείς που νοσηλεύτηκαν για παρόξυνση ΧΑΠ σε 4 τεταρτοβάθμια νοσοκομεία της Ελλάδος. Στην εισαγωγή πραγματοποιήθηκε καταγραφή των επιπέδων της HbA1c και υπολογισμός των HbA1c-σχετιζόμενων μεταβλητών. Συσχέτιση αυτών έγινε με τη διάρκεια νοσηλείας, τη χρήση μηχανικού αερισμού και την έκβαση νοσηλείας. Ακολούθησε παρακολούθηση των ασθενών για ένα έτος και καταγράφηκαν νέα επεισόδια παροξύνσεων και θάνατοι. Αποτελέσματα: Μελετήθηκαν 156 ασθενείς ( 74.4% άνδρες, ηλικία [meanSD] 72 7 έτη). Το 23.1% αυτών έπασχαν από ΣΔΙΙ και το 67.9% ελάμβανε αγωγή με ICS. Η διάμεση τιμή HbA1c ήταν 5.9 (IQR: 5.4, 6.5). Η χρήση επεμβατικού μηχανικού αερισμού ήταν σημαντικά υψηλότερη για ασθενείς με χαμηλότερα επίπεδα HbA1c [median : 5.3 (IQR 5.02, 6.3) vs 5.9 (IQR 5.5, 6.5), p=0.038]. Ωστόσο η διάρκεια νοσηλείας, η τιμή του PO2/ FiO2 η θνητότητα της παρόξυνσης και ο αριθμός των παροξύνσεων και η θνητότητα εντός του επόμενου έτους δεν διέφεραν. Δεν διαπιστώθηκε καμία σημαντική διαφορά βάσει των HbA1c σχετιζόμενων μεταβλητών. Συμπέρασμα: Η προγενέστερη και η σύγχρονη της παρόξυνσης γλυκαιμική κατάσταση δεν δύναται να προβλέψει βραχυπρόθεσμα ή μακροπρόθεσμα αποτελέσματα της νόσου για το σύνολο των ασθενών.

Intraoperative hyperglycemic stress response and tissue perfusion in cardiac surgery

Background and aim of the study Approximately 30% of patients undergoing cardiac surgery have a history of diabetes and 60-80% of patients without diabetes have stress hyperglycemia. We examined patients undergoing cardiac surgery to determine the presence of stress hyperglycemia and its relationship to tissue perfusion. Methods Hemodynamic parameters, central venous oxygen saturation, lactate,oxygen delivery and consumption, oxygen extraction rate were analyzed at four intraoperative time points. Results The stress-induced hyperglycemic response during cardiac surgery was more severe in patients without diabetes. When focusing on the oxygen extraction rate in terms of tissue oxygenation, diabetic patients had 1.22 times higher and significant oxygen extraction rate than non-diabetic patients. Conclusions Although lactate values were slightly higher and central venous oxygen saturation were slightly lower in the diabetic group, considering the fact that oxygen extraction rate reflects the total outcome of small changes in all these parameters, we can emphasize the conclusion that diabetic patients undergoing cardiac surgery have greater tissue oxygen demand/supply imbalance compared to non-diabetic patients. In our study, this tissue oxygenation defect in diabetic patients was not found to be directly correlated with blood glucose levels. Perhaps, even if the disease is under control, the negative effects of diabetes on all systems have accumulated and led to such a result.