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Admission hyperglycemia in critically ill sepsis patients: Association with outcome and host response
Open accessAbstract
Objectives: To investigate whether admission hyperglycemia is associated with the presentation and/or outcome of sepsis, what the influence of hyperglycemia is on key host responses to sepsis, and whether hyperglycemia differentially affects patients with diabetes mellitus. Design and Setting: A substudy of a prospective observational cohort study was conducted in the intensive care of two tertiary hospitals between January 2011 and July 2013. Patients: Of all consecutive critically ill sepsis patients, admission glucose was used to stratify patients in euglycemia (71–140 mg/dL), mild hyperglycemia (141–199 mg/dL), and severe hyperglycemia (≥ 200 mg/dL), and patients with hypoglycemia were excluded. Fifteen plasma biomarkers providing insight in key host responses implicated in sepsis pathogenesis were measured on admission. Measurements and Main Results: Of 987 sepsis patients with admission glucose levels greater than 70 mg/dL, 519 (52.6%) had normal glucose levels, 267 (27.1%) had mild, and 201 (20.4%) severe hyperglycemia. Admission hyperglycemia was accompanied by mitigated alterations in plasma host response biomarker levels indicative of activation of the cytokine network, the vascular endothelium, and the coagulation system in patients without a history of diabetes. Severe, but not mild, admission hyperglycemia was associated with increased 30-day mortality (adjusted hazard ratio, 1.66 [95% CI, 1.24–2.23]), in both patients without diabetes (adjusted hazard ratio, 1.65 [95% CI, 1.12–2.42]) and with diabetes (adjusted hazard ratio, 1.91 [95% CI, 1.01–3.62]). Conclusion: Admission hyperglycemia is associated with adverse outcome of sepsis irrespective of the presence or absence of preexisting diabetes by a mechanism unrelated to exaggerated inflammation or coagulation.
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“Inpatient hyperglycemia is associated with increased complications including surgical site infections, mortality, and increased length of hospital stay.91–93”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [91]
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“Those without preexisting DM or stress hyperglycemia have a higher incidence of more postheart surgery complications.91,100–103”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [91]
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“abetes hospitalized for COVID-19 and is common among acute hospital admissions and critically ill patients, encompassing those with no previous history of hyperglycemia (1,2).”
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Metadata
- Authors
- van Vught, L. A., Wiewel, M. A., Klein Klouwenberg, P. M. C., Hoogendijk, A. J., Scicluna, B. P., Ong, D. S. Y., Cremer, O. L., Horn, J., Bonten, M. M. J., Schultz, M. J., & van der Poll, T.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- University Medical Center Utrecht (NL)
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.
- ORCID
- Venue
- Critical Care Medicine
- Published
- 2016-07
- Volume
- 44
- Issue
- 7
- Pages
- 1338-1346
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2295634666
- Cited by
- 130
- References
- 49
- Citations by year
- 2026: 6 · 2025: 18 · 2024: 10 · 2023: 16 · 2022: 8 · 2021: 16 · 2020: 14 · 2019: 17 · 2018: 9 · 2017: 7 · 2016: 9
- FWCI
- 14.05
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- Center for Translational Molecular Medicine (04I-201)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- sepsis, admission hyperglycemia, critically ill patients, host response biomarkers, diabetes mellitus, 30-day mortality, cytokine network, vascular endothelium, coagulation, plasma biomarkers, intensive care
- MeSH terms
- Aged, Female, Hospitalization, Hospitals, Teaching, Humans, Hyperglycemia, Intensive Care Units, Male, Middle Aged, Prospective Studies, Critical Illness, Sepsis, Diabetes Complications
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