Variabilidad de la Glicemia y Morbimortalidad del Paciente Crítico

Autores/as

  • Alejandro Bautista Hurtarte Universidad Francisco Marroquín
  • Sergy Melissa Campos Martínez Universidad Francisco Marroquín
  • Jorge Luis Ranero Meneses Universidad Francisco Marroquín

DOI:

https://doi.org/10.37345/23045329.v1i32.82

Palabras clave:

glucosa, variabilidad de glucosa capilar, mortalidad, morbilidad

Resumen

Introducción: Los pacientes ingresados al área de cuidado crítico están sujetos a monitoreo constante con el fin de optimizar su manejo médico y ofrecer el mejor pronóstico posible. Dentro de las estrategias de monitoreo, los niveles de glicemia han sido altamente estudiados ya que se consideran factor de riesgo significativo para aumento de la morbimortalidad de estos pacientes. Objetivo: Correlacionar la variabilidad de glucosa capilar con la morbimortalidad intrahospitalaria de pacientes en la unidad de cuidados críticos del Hospital General de Enfermedades del Instituto Guatemalteco de Seguridad Social.  Metodología: Se realizó un estudio descriptivo y analítico de tipo prospectivo, por medio del análisis estadístico de correlación.  Se incluyeron un total de 290 pacientes ingresados en la unidad de cuidados intensivos del IGSS, a los cuáles se les realizaron pruebas de glucosa capilar para luego determinar la variabilidad de glucosa capilar utilizando la desviación estándar. Esta se correlacionó con la morbimortalidad.  Resultados: Los pacientes que presentan una mayor desviación estándar de glucosa se correlaciona con una mayor mortalidad (R=0.249, R2=0.06, p<0.001) y morbilidad dada por la escala SOFA (R=0.27, R2=0.07, p<0.001).  Conclusión: El estudio demostró que un aumento en la variabilidad de glucosa capilar, se correlaciona con un aumento en la morbimortalidad de los pacientes durante su estadía en el área de cuidado crítico.

Referencias

Adhikari, N., Fowler, R., Bhagwanjee, S., Rubenfeld, G. Critical care and the global burden of critical illness in adults. The Lancet. 2010, Oct.; 376(9749): 1339-1346. https://doi.org/10.1016/S0140-6736(10)60446-1 DOI: https://doi.org/10.1016/S0140-6736(10)60446-1

Cavalcanti, A.B., Bozza, F.A., Machado, F.R., Salluh, J., Pelisser Campagnucci, V., Vendramim, P., Guimaraes, H.P., Normilio-Silva, K., Petri Damiani, L., Romano, E., Carrara, F., Lubarino Diniz de Sousa, J., Reis Silva, A., Ramos, G. V., Teixeira, C., Da silva, N.B., Chang-Chou, C.C., Angus, D.C., Berwanger, O. Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients: a randomized clinical trial. JAMA. 2016, April; 315(2): 1480-1490. https://doi.org/10.1001/jama.2016.3463 DOI: https://doi.org/10.1001/jama.2016.3463

World Health Organization. Global Health Risks: mortality and burden of disease attributable to selected major risks. WHO, 2009; 62 p. https://apps.who.int/iris/handle/10665/44203

Finney, S.J., Zekveld, C., Elia, A., Evans, T.W. Glucose control and mortality in critically ill patients. JAMA. 2003, Oct.; 290(15): 2041-2047. https://doi.org/10.1001/jama.290.15.2041 DOI: https://doi.org/10.1001/jama.290.15.2041

Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001, Dec.; 414(6865): 813–820. https://doi.org/10.1038/414813a DOI: https://doi.org/10.1038/414813a

Brownlee, M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005, June.; 54(6): 1615–1625. https://doi.org/10.2337/diabetes.54.6.1615 DOI: https://doi.org/10.2337/diabetes.54.6.1615

Brownlee, M., Hirsch, I.B. Glycemic variability: a hemoglobin A1c-independent risk factor for diabetic complications. JAMA. 2006, April; 295(14): 1707–1708. https://doi.org/10.1001/jama.295.14.1707 DOI: https://doi.org/10.1001/jama.295.14.1707

Chao, H.Y., Liu, P.-H., Lin, S.C., Chen, C.K., Chen, J.C., Chan, Y.L., Wu, C.C., Blaney, G.N., Liu, Z.Y., Wu, C.J., Chen, K.-F. Association of In-Hospital Mortality and Dysglycemia in Septic Patients. PLOS One. 2017, January; 12, e0170408. https://doi.org/10.1371/journal.pone.0170408 DOI: https://doi.org/10.1371/journal.pone.0170408

Wiener RS, Wiener DC, Larson RJ. (2008) Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008, Aug.; 300(8): 933–944. https://doi.org/10.1001/jama.300.8.933 DOI: https://doi.org/10.1001/jama.300.8.933

Griesdale, D.E., de Souza, R.J., van Dam, R.M., Heyland, D.K., Cook, D.J., Malhotra, A., Dhaliwal, R., Henderson, W.R., Chittock, D.R., Finfer, S., Talmor, D. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. Canadian Medical Association Journal. 2009, April; 180(8): 821-827. https://doi.org/10.1503/cmaj.090206 DOI: https://doi.org/10.1503/cmaj.090206

DeVries, J.H. Glucose Variabilty: Where it is Important and How to Measure It. Diabetes. 2013, May; 62(5): 1405-1408. https://doi.org/10.2337/db12-1610 DOI: https://doi.org/10.2337/db12-1610

Krinsley, J.S., Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med. 2017, Oct.; 35(10): 2262-2267. https://doi.org/10.1097/01.CCM.0000282073.98414.4B DOI: https://doi.org/10.1097/01.CCM.0000282073.98414.4B

Bagshaw, S.M., Bellomo, R., Jacka, M.J., Egi, M., Hart, G.K. George, C., The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Crit Care. 2009, June; 13(3): R91 https://doi.org/10.1186/cc7921 DOI: https://doi.org/10.1186/cc7921

Jay, D., Hitomi, H., Griendling, K.K.. Oxidative stress and diabetic cardiovascular complications. Free Radic Biol Med. 2006, Jan.; 40(2): 183–192. https://doi.org/10.1016/j.freeradbiomed.2005.06.018 DOI: https://doi.org/10.1016/j.freeradbiomed.2005.06.018

Piconi, L., Quagliaro, L., Assaloni, R., Da Ros, R., Maier, A., Zuodar, G., Ceriello, A. Constant and intermittent high glucose enhances endothelial cell apoptosis through mitochondrial superoxide overproduction. Diabetes Metab Res Rev. 2006, May-June; 22(3): 198 –203. https://doi.org/10.1002/dmrr.613 DOI: https://doi.org/10.1002/dmrr.613

Takeuchi, A., Throckmorton, D.C., Brogden, A.P., Yoshizawa, N., Rasmussen, H., Kashgarian, M. Periodic high extracellular glucose enhances production of collagens III and IV by mesangial cells. Am J Physiol. 1995, Jan.; 268(1 Pt 2): F13-9. https://doi.org/10.1152/ajprenal.1995.268.1.F13 DOI: https://doi.org/10.1152/ajprenal.1995.268.1.F13

Monnier, L., Mas, E., Ginet, C., Michel, F., Villon, L., Cristol, J.P., Colette, C. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006, April; 295(14): 1681-1687. https://doi.org/10.1001/jama.295.14.1681 DOI: https://doi.org/10.1001/jama.295.14.1681

Kilpatrick, E.S., Rigby, A.S., Atkin, S.L. Variability in the relationship between mean plasma glucose and HbA1c: implications for the assessment of glycemic control. Clin Chem. 2007, May; 53(5): 897-901. https://doi.org/10.1373/clinchem.2006.079756 DOI: https://doi.org/10.1373/clinchem.2006.079756

Siegelaar, S.E., Holleman, F., Hoekstra, J.B.L., & DeVries, J.H. Glucose Variability: Does it matter? Endocrine Reviews. 2010, April; 31(2): 171-182. https://doi.org/10.1210/er.2009-0021 DOI: https://doi.org/10.1210/er.2009-0021

Eslami, S., Taherzadeh, Z., Schultz, M., & Abu-Hanna, A. Glucose variability measures and their effect on mortality: a systematic review. Intensive Care Medicine. 2011, April; 37(4): 583-593. https://doi.org/10.1007/s00134-010-2129-5 DOI: https://doi.org/10.1007/s00134-010-2129-5

Todi, S., & Bhattacharya, M. Glycemic variability and outcome in critically ill. Indian Journal of Critical Care Medicine. 2014, May; 18(5): 285–290. https://doi.org/10.4103/0972-5229.132484 DOI: https://doi.org/10.4103/0972-5229.132484

Vincent, J.L. Blood glucose control in 2010: 110 to 150 mg/dL and minimal variability. Critical Care Medicine. 2010, March; 38(3): 993–995. https://doi.org/10.1097/CCM.0b013e3181d16b2e DOI: https://doi.org/10.1097/CCM.0b013e3181d16b2e

Ali, N.A., O’Brien, Jr., J.M., Dungan, K., Phillips, G., Marsh, C.B., Lemeshow, S., Connors, Jr., A.F., Preiser. J.C. Glucose variability and mortality in patients with sepsis. Critical Care Medicine. 2008, August; 36(8): 2316-2321. https://doi.org/10.1097/CCM.0b013e3181810378 DOI: https://doi.org/10.1097/CCM.0b013e3181810378

Dossett LA, Cao H, Mowery NT, Dortch MJ, Morris JM Jr, May AK. Blood glucose variability is associated with mortality in the surgical intensive care unit. Am., Surg. 2008, August; 74(8): 679-685; discussion 685. https://doi.org/10.1177/000313480807400802 DOI: https://doi.org/10.1177/000313480807400802

Egi, M., Bellomo, R., Stachowski, E., French, C.J., Hart, G. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006, August; 105(2): 244-252. https://doi.org/10.1097/00000542-200608000-00006 DOI: https://doi.org/10.1097/00000542-200608000-00006

Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics; 2006, July; 118(1): 173-179. https://doi.org/10.1542/peds.2005-1819 DOI: https://doi.org/10.1542/peds.2005-1819

Akirov, A., Diker-Cohen, T., Masri-Iraqi, H., & Shimon, I. High Glucose Variability Increases Mortality Risk in Hospitalized Patients. J. Clinical Endocrinology Metabolism. 2017, July; 102(7): 2230-2241. https://doi.org/10.1210/jc.2017-00450 DOI: https://doi.org/10.1210/jc.2017-00450

Mendez, C.E., Mok, K.T., Ata, A., Tanenberg, R.J., Calles-Escandon, J., Umpierrez, G.E. Increased glycemic variability is independently associated with length of stay and mortality in noncritically ill hospitalized patients. Diabetes Care; 2013, Dec.; 36(12): 4091–4097. https://doi.org/10.2337/dc12-2430 DOI: https://doi.org/10.2337/dc12-2430

NICE-SUGAR Study Investigators, Finfer, S., Chittock, D.R., Intensive versus conventional glucose control in critically ill patients. N Engl J Me; 2009, March; 360(13): 1283-1297. https://doi.org/10.1056/NEJMoa0810625 DOI: https://doi.org/10.1056/NEJMoa0810625

Papachristoforou, E., Lambadiari, V., Maratou, E., Makrilakis, K. Association of Glycemic

Indices (Hyperglycemia, Glucose Variability, and Hypoglycemia) with Oxidative Stress and Diabetic Complications. J Diabetes Res; 2020; October; 7489795795. https://doi.org/10.1155/2020/7489795 DOI: https://doi.org/10.1155/2020/7489795

Mendez, C.E., Mok, K.T., Ata, A., Tanenberg, R.J., Calles-Escandon,, J., Umpierrez, G.E. Increased glycemic variability is independently associated with length of stay and mortality in noncritically ill hospitalized patients. Diabetes Care. 2013, December; 36(12): 4091–4097. https://doi.org/10.2337/dc12-2430 DOI: https://doi.org/10.2337/dc12-2430

Hemanides, J., Vriesendrop, T.M., Bosman, R.J., Zandstra, D.F., Hoekstra, J.B., & DeVries, J.H. Glucose variability is associated with intensive care unit mortality. Critical Care Medicine. 2010, Mar; 38(3):838-842. https://doi.org/10.1097/CCM.0b013e3181cc4be9 DOI: https://doi.org/10.1097/CCM.0b013e3181cc4be9

Cook, D. J. Approach to the Patient in a Critical Care Setting. In L. Goldman, & A. Schafer, Goldman-Cecil Medicine. 26th ed. Part 10: Critical care medicine. Cecil. 2020;1(26). https://booksite.elsevier.com/samplechapters/9781437716047/Sample%20Chapters%20and%20Table%20of%20Contents.pdf

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30-06-2022

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Variabilidad de la Glicemia y Morbimortalidad del Paciente Crítico. (2022). Revista De La Facultad De Medicina, 1(32), 67-86. https://doi.org/10.37345/23045329.v1i32.82

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