An elevated glycemic gap predicts adverse outcomes in diabetic patients with necrotizing fasciitis
Autoři:
Po-Chuan Chen aff001; Shih-Hung Tsai aff001; Jen-Chun Wang aff001; Yuan-Sheng Tzeng aff003; Yung-Chih Wang aff004; Chi-Ming Chu aff005; Shi-Jye Chu aff006; Wen-I Liao aff001
Působiště autorů:
Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
aff001; Department of Physiology and Biophysics, Graduate Institute of Physiology, National Defense Medical Center, Taipei, Taiwan
aff002; Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
aff003; Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
aff004; School of Public Health, National Defense Medical Center, Taipei, Taiwan
aff005; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
aff006
Vyšlo v časopise:
PLoS ONE 14(10)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0223126
Souhrn
Background
Diabetes is the most common comorbidity of necrotizing fasciitis (NF), but the effect of stress-induced hyperglycemia (SIH) on diabetic patients with NF has never been investigated. The aim of this study was to assess whether SIH, as determined by the glycemic gap between admission glucose levels and A1C-derived average glucose levels, predicts adverse outcomes in diabetic patients hospitalized with NF.
Methods
We retrospectively reviewed the glycemic gap and clinical outcomes in 252 diabetic patients hospitalized due to NF from 2011 to 2018 in a single medical center in Taiwan. A receiver operating characteristic (ROC) curve was used to analyze the optimal cutoff values for predicting adverse outcomes. Univariate and multivariate logistic regression analyses were employed to identify significant predictors of adverse outcomes.
Results
In total, 194 diabetic NF patients were enrolled. Compared with patients without adverse outcomes, patients with adverse outcomes had significantly higher glycemic gaps, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and C-reactive protein (CRP) levels; lower albumin and hemoglobin levels; greater incidence of limb loss; and longer hospital and intensive care unit stays. The glycemic gap positively correlates with the laboratory risk indicator for NF scores, APACHE II scores and CRP levels. A glycemic gap of 146 mg/dL was the optimal cutoff value for predicting adverse outcomes using the ROC curve. Compared with patients with glycemic gaps ≤146 mg/dL, those with glycemic gaps >146 mg/dL had higher APACHE II scores and incidence rates of adverse outcomes, especially bacteremia and acute kidney injury. Multivariate analysis revealed that a glycemic gap >146 mg/dL and APACHE II score >15 were independent predictors of adverse outcomes, while the presence of hyperglycemia at admission was not.
Conclusions
An elevated glycemic gap was significantly independently associated with adverse outcomes in diabetic NF patients. Further prospective studies are warranted to validate the role of the glycemic gap in NF patients with diabetes.
Klíčová slova:
Hyperglycemia – Methicillin-resistant Staphylococcus aureus – Body limbs – Glucose – Sepsis – Bacteremia
Zdroje
1. Boyer A, Vargas F, Coste F, Saubusse E, Castaing Y, Gbikpi-Benissan G, et al. Influence of surgical treatment timing on mortality from necrotizing soft tissue infections requiring intensive care management. Intensive Care Med. 2009;35(5):847–53. Epub 2008/12/23. doi: 10.1007/s00134-008-1373-4 19099288.
2. Bernal NP, Latenser BA, Born JM, Liao J. Trends in 393 necrotizing acute soft tissue infection patients 2000–2008. Burns: journal of the International Society for Burn Injuries. 2012;38(2):252–60. Epub 2011/10/28. doi: 10.1016/j.burns.2011.07.008 22030440.
3. Hua C, Sbidian E, Hemery F, Decousser JW, Bosc R, Amathieu R, et al. Prognostic factors in necrotizing soft-tissue infections (NSTI): A cohort study. Journal of the American Academy of Dermatology. 2015;73(6):1006–12 e8. Epub 2015/09/29. doi: 10.1016/j.jaad.2015.08.054 26412163.
4. Huang KF, Hung MH, Lin YS, Lu CL, Liu C, Chen CC, et al. Independent predictors of mortality for necrotizing fasciitis: a retrospective analysis in a single institution. The Journal of trauma. 2011;71(2):467–73; discussion 73. Epub 2011/08/10. doi: 10.1097/TA.0b013e318220d7fa 21825948.
5. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. The Journal of bone and joint surgery American volume. 2003;85-A(8):1454–60. Epub 2003/08/20. 12925624.
6. Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. The British journal of surgery. 2014;101(1):e119–25. Epub 2013/12/18. doi: 10.1002/bjs.9371 24338771.
7. Tan JH, Koh BT, Hong CC, Lim SH, Liang S, Chan GW, et al. A comparison of necrotising fasciitis in diabetics and non-diabetics: a review of 127 patients. Bone Joint J. 2016;98-B(11):1563–8. Epub 2016/11/03. doi: 10.1302/0301-620X.98B11.37526 27803235.
8. Cheng NC, Tai HC, Chang SC, Chang CH, Lai HS. Necrotizing fasciitis in patients with diabetes mellitus: clinical characteristics and risk factors for mortality. BMC infectious diseases. 2015;15:417. Epub 2015/10/16. doi: 10.1186/s12879-015-1144-0 26463900; PubMed Central PMCID: PMC4604726.
9. Marik PE, Raghavan M. Stress-hyperglycemia, insulin and immunomodulation in sepsis. Intensive Care Med. 2004;30(5):748–56. Epub 2004/03/03. doi: 10.1007/s00134-004-2167-y 14991101.
10. Gore DC, Chinkes D, Heggers J, Herndon DN, Wolf SE, Desai M. Association of hyperglycemia with increased mortality after severe burn injury. The Journal of trauma. 2001;51(3):540–4. Epub 2001/09/06. doi: 10.1097/00005373-200109000-00021 11535907.
11. McAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ. The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care. 2005;28(4):810–5. Epub 2005/03/29. doi: 10.2337/diacare.28.4.810 15793178.
12. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355(9206):773–8. Epub 2000/03/11. doi: 10.1016/S0140-6736(99)08415-9 10711923.
13. Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM. Admission hyperglycemia is predictive of outcome in critically ill trauma patients. The Journal of trauma. 2005;59(1):80–3. Epub 2005/08/13. doi: 10.1097/01.ta.0000171452.96585.84 16096543.
14. Egi M, Bellomo R, Stachowski E, French CJ, Hart GK, Taori G, et al. The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes. Crit Care Med. 2011;39(1):105–11. Epub 2010/10/27. doi: 10.1097/CCM.0b013e3181feb5ea 20975552.
15. Schuetz P, Kennedy M, Lucas JM, Howell MD, Aird WC, Yealy DM, et al. Initial management of septic patients with hyperglycemia in the noncritical care inpatient setting. Am J Med. 2012;125(7):670–8. Epub 2012/05/23. S0002-9343(12)00244-6 [pii] doi: 10.1016/j.amjmed.2012.03.001 22608986.
16. Stegenga ME, Vincent JL, Vail GM, Xie J, Haney DJ, Williams MD, et al. Diabetes does not alter mortality or hemostatic and inflammatory responses in patients with severe sepsis. Crit Care Med. 2010;38(2):539–45. Epub 2009/10/24. doi: 10.1097/CCM.0b013e3181c02726 19851093.
17. Schuetz P, Friedli N, Grolimund E, Kutz A, Haubitz S, Christ-Crain M, et al. Effect of hyperglycaemia on inflammatory and stress responses and clinical outcome of pneumonia in non-critical-care inpatients: results from an observational cohort study. Diabetologia. 2014;57(2):275–84. Epub 2013/11/26. doi: 10.1007/s00125-013-3112-9 24270903.
18. van Vught LA, Holman R, de Jonge E, de Keizer NF, van der Poll T. Diabetes Is Not Associated With Increased 90-Day Mortality Risk in Critically Ill Patients With Sepsis. Crit Care Med. 2017;45(10):e1026–e35. Epub 2017/07/25. doi: 10.1097/CCM.0000000000002590 28737575.
19. Richards JE, Kauffmann RM, Obremskey WT, May AK. Stress-induced hyperglycemia as a risk factor for surgical-site infection in nondiabetic orthopedic trauma patients admitted to the intensive care unit. J Orthop Trauma. 2013;27(1):16–21. Epub 2012/05/17. doi: 10.1097/BOT.0b013e31825d60e5 22588532; PubMed Central PMCID: PMC3507335.
20. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ. Translating the A1C assay into estimated average glucose values. Diabetes care. 2008;31(8):1473–8. Epub 2008/06/10. dc08-0545 [pii] doi: 10.2337/dc08-0545 18540046.
21. Chen PC, Liao WI, Wang YC, Chang WC, Hsu CW, Chen YH, et al. An Elevated Glycemic Gap is Associated With Adverse Outcomes in Diabetic Patients With Community-Acquired Pneumonia. Medicine. 2015;94(34):e1456. Epub 2015/08/28. doi: 10.1097/MD.0000000000001456 26313809.
22. Liao WI, Lin CS, Lee CH, Wu YC, Chang WC, Hsu CW, et al. An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction. Scientific reports. 2016;6:27770. Epub 2016/06/14. doi: 10.1038/srep27770 27291987; PubMed Central PMCID: PMC4904212.
23. Liao WI, Sheu WH, Chang WC, Hsu CW, Chen YL, Tsai SH. An elevated gap between admission and A1C-derived average glucose levels is associated with adverse outcomes in diabetic patients with pyogenic liver abscess. PloS one. 2013;8(5):e64476. Epub 2013/06/01. doi: 10.1371/journal.pone.0064476 23724053; PubMed Central PMCID: PMC3665809.
24. Yang CJ, Liao WI, Wang JC, Tsai CL, Lee JT, Peng GS, et al. Usefulness of glycated hemoglobin A1c-based adjusted glycemic variables in diabetic patients presenting with acute ischemic stroke. Am J Emerg Med. 2017;35(9):1240–6. Epub 2017/04/02. doi: 10.1016/j.ajem.2017.03.049 28363620.
25. Yang CJ, Liao WI, Tang ZC, Wang JC, Lee CH, Chang WC, et al. Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2017;12:1923–32. Epub 2017/07/26. doi: 10.2147/COPD.S131232 28740373; PubMed Central PMCID: PMC5505159.
26. Wang CH, Chang JL, Huang CH, Chang WT, Tsai MS, Yu PH, et al. The association between long-term glycaemic control, glycaemic gap and neurological outcome of in-hospital cardiac arrest in diabetics: A retrospective cohort study. Resuscitation. 2018;133:18–24. Epub 2018/09/28. doi: 10.1016/j.resuscitation.2018.09.017 30261218.
27. Rau CS, Wu SC, Chen YC, Chien PC, Hsieh HY, Kuo PJ, et al. Stress-Induced Hyperglycemia in Diabetes: A Cross-Sectional Analysis to Explore the Definition Based on the Trauma Registry Data. Int J Environ Res Public Health. 2017;14(12). Epub 2017/12/08. doi: 10.3390/ijerph14121527 29215581; PubMed Central PMCID: PMC5750945.
28. Zitkus BS. Update on the American Diabetes Association Standards of Medical Care. Nurse Pract. 2014;39(8):22–32; quiz -3. Epub 2014/07/01. doi: 10.1097/01.NPR.0000451880.48790.50 24979246.
29. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. 2016;315(8):801–10. Epub 2016/02/24. doi: 10.1001/jama.2016.0287 26903338; PubMed Central PMCID: PMC4968574.
30. Schuetz P, Castro P, Shapiro NI. Diabetes and sepsis: preclinical findings and clinical relevance. Diabetes Care. 2011;34(3):771–8. Epub 2011/03/02. doi: 10.2337/dc10-1185 21357364; PubMed Central PMCID: PMC3041224.
31. Graham BB, Keniston A, Gajic O, Trillo Alvarez CA, Medvedev S, Douglas IS. Diabetes mellitus does not adversely affect outcomes from a critical illness. Crit Care Med. 2010;38(1):16–24. Epub 2009/10/01. doi: 10.1097/CCM.0b013e3181b9eaa5 19789450.
32. Kornum JB, Thomsen RW, Riis A, Lervang HH, Schonheyder HC, Sorensen HT. Type 2 diabetes and pneumonia outcomes: a population-based cohort study. Diabetes Care. 2007;30(9):2251–7. Epub 2007/06/28. doi: 10.2337/dc06-2417 17595354.
33. Jabbour G, El-Menyar A, Peralta R, Shaikh N, Abdelrahman H, Mudali IN, et al. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emerg Surg. 2016;11:40. Epub 2016/08/11. doi: 10.1186/s13017-016-0097-y 27508002; PubMed Central PMCID: PMC4977757.
34. Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Annals of surgery. 1996;224(5):672–83. Epub 1996/11/01. doi: 10.1097/00000658-199611000-00011 8916882; PubMed Central PMCID: PMC1235444.
35. Oncul O, Erenoglu C, Top C, Kucukardali Y, Karabudak O, Kurt Y, et al. Necrotizing fasciitis: A life-threatening clinical disorder in uncontrolled type 2 diabetic patients. Diabetes research and clinical practice. 2008;80(2):218–23. Epub 2008/01/15. doi: 10.1016/j.diabres.2007.12.001 18190995.
36. Roberts GW, Quinn SJ, Valentine N, Alhawassi T, O'Dea H, Stranks SN, et al. Relative Hyperglycemia, a Marker of Critical Illness: Introducing the Stress Hyperglycemia Ratio. J Clin Endocrinol Metab. 2015;100(12):4490–7. Epub 2015/10/21. doi: 10.1210/jc.2015-2660 26485219.
37. Ahn CH, Min SH, Lee DH, Oh TJ, Kim KM, Moon JH, et al. Hemoglobin Glycation Index Is Associated With Cardiovascular Diseases in People With Impaired Glucose Metabolism. J Clin Endocrinol Metab. 2017;102(8):2905–13. Epub 2017/05/26. doi: 10.1210/jc.2017-00191 28541544; PubMed Central PMCID: PMC6283438.
38. Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Schonheyder HC, Sorensen HT. Diabetes mellitus as a risk and prognostic factor for community-acquired bacteremia due to enterobacteria: a 10-year, population-based study among adults. Clin Infect Dis. 2005;40(4):628–31. Epub 2005/02/16. doi: 10.1086/427699 15712091.
39. Uehara K, Yasunaga H, Morizaki Y, Horiguchi H, Fushimi K, Tanaka S. Necrotising soft-tissue infections of the upper limb: risk factors for amputation and death. Bone Joint J. 2014;96-B(11):1530–4. Epub 2014/11/06. doi: 10.1302/0301-620X.96B11.34888 25371469.
40. Liu X, Shen Y, Li Z, Fei A, Wang H, Ge Q, et al. Prognostic significance of APACHE II score and plasma suPAR in Chinese patients with sepsis: a prospective observational study. BMC Anesthesiol. 2016;16(1):46. Epub 2016/07/31. doi: 10.1186/s12871-016-0212-3 27473112; PubMed Central PMCID: PMC4966698.
41. Beauchamp LC, Mostafavifar LG, Evans DC, Gerlach AT. Sweet and Sour: Impact of Early Glycemic Control on Outcomes in Necrotizing Soft-Tissue Infections. Surg Infect (Larchmt). 2019. Epub 2019/02/05. doi: 10.1089/sur.2018.182 30716012.
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