2nd Journal Reading

8/20/2019 2nd Journal Reading

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2nd journal reading

Emal Suhedi

Hyperglycemia in sepsis is

a risk factor for development of

type II diabetes


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no diabetes

Hyperglycemia acut infection sepsis

no impaired glucose

metabolism

consequence of inflammatory

response and stress


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the existence of latent disturbance of glucose

metabolism that contributes to the development ofhyperglycemia and the patients might have

increased risk for diabetes


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• To observe Hyperglycaemia at Sepsis as the

risk factor for development of DM T2


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Patients

• dult Sepsis

• The Medical !ntensive "are #nit $!"#%& #niversity

Hospital 'ebro

• ( years $ July 1998-June 2003%• )egative History for Diabetes Mellitus $DM%&

!mpaired fasting glucose $!*+% or

!mpaired glucose tolerance $!+T%

methods

• prospective& noninterventional single,center study

-

--


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• The follo-ing data -ere collected for all patients. Age,Sex,Family History of Diabetes, Body Mass Index(BMI), Serum Colesterol and !rigly"eride"on"entrations#

• dmission cute /hysiology and "hronic Health 0valuation

$/"H0 !!% score

• Sequential 1rgan ssessment Score $S1*% score

•lood glucose $venous% 2 times a day. at 3 M $fasting% and3 /M $2 hours postprandial%4

• 5enous blood -as analy6ed on point,of,care analy6er

(I$ %&M 'remier * Instrumentation $aboratory,

$exington, M+, S+)#


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exclusion criteria

• !*+& !+T& or DM $ 7 %

• "orticosteroid treatment duringthe !"# admission or 2 monthsbefore the !"# admission

• 0ndocrine disorder that mayalter glucose metabolism

• Disseminated malignantdisease or any other acute orchronic condition

• /atients -ho -ere un-illing toparticipate

• /atients -ith only 8hyperglycemic value

• !*+& !+T& or DM $ 7 %• "orticosteroid treatment during

the !"# admission or 2 monthsbefore the !"# admission

• 0ndocrine disorder that mayalter glucose metabolism

• Disseminated malignantdisease or any other acute orchronic condition

• /atients -ho -ere un-illing toparticipate

• /atients -ith only 8

hyperglycemic value

• dult patients -ith

sepsis admitted to the

medical intensive care

unit $!"#%

• no history of impairedglucose metabolism$ IFG, IGT, or DM %

• dult patients -ithsepsis admitted to the

medical intensive care

unit $!"#%

• no history of impairedglucose metabolism$ IFG, IGT, or DM %

inclusion criteria


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IGTIGT IFGIFG

DMDM

D

criteria

D

criteria

• Med"alc v4 942484: statistical soft-are -as used for all statistical analyses

• patients -ith hyperglycemia during sepsis are at increased risk of developing type 2

diabetes mellitus or impaired glucose metabolism $!*+ or !+T%

• The results also confirm previously kno-n fact that hyperglycemia is more frequent in

more severe disease and that it is associated -ith higher mortality risk

• /atients -ith hyperglycemia did have higher M! and higher triglyceride

concentrations& -hich maybe a reflection of their greater susceptibility to

hyperglycemia

severe

sepsis septicshock

Sepsis

the usual

criteria


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• More severely ill have more chance of developinghyperglycemia even -ith normal metabolism& and therefore

have smaller risk of developing diabetes in the follo-,up

period

• Substantiates hypothesis that there is some other factor

contributing to hyperglycemia other than severity of disease

• 'esearcher . hyperglycemia during critical illness as venous

blood glucose concentration )949 mmol;< $8=: mg;d


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• Hyperglycemia in nondiabetic patients -ith sepsisis related to severity of illness and probably to an

intrinsic disturbance of glucose metabolism4

• Hyperglycemia is associated -ith =,fold risk fordevelopment of diabetes mellitus and double risk

for development of !*+ or !+T in the ( years after

septic episode4

• /atients -ith hyperglycemia in sepsis should be

follo-ed up as high,risk population for development

of diabetes4


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I. Is the evidence about this prognosis aspect valid?

ere the patients collected as sa!ple clear and representative in

a point o" diseases progress? #es

as the observation long enough and co!plete? no

as the ob$ective out co!e criteria applied %ith blind? yes

I" the subgroup %ith di&erent prognosis %as identi'ed(

•as there ad$ust!ent "or i!portant prognosis "actor?

•%as independent validation conducted to test set patient

groups?

#es

#es


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I. Is this evidence about this valid prognosis aspect important?

How big the probability of the outcome in

the long time period?

How precise the estimation of the

prognosis?

If we calculate a condence interval of this prognosis aspect?

Clinical measurement Standar Error CI calculation

n of our evidence = p of our evidence =

!"#$

= %&!"#$'(#)

!"#$*+

= !"!$,

SE = !"!$, ( $",- *

-

CI = !"#$ /(#", ' !"!$,*

= !"#$ / !"!#

= !.! ) !"01 ( - ) 01- *


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I. Can we applied this prognosis aspect evidence to our

patient?

2re the patients in this studysimilar with our patients?

no

3o this evidence have an

importance in4uence

clinically to our conclusion

about what need to o5er ortell to our patient?

6es


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I)*+,I)


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sepsissepsis

inflammationinflammation

neuroendocrineneuroendocrine

hypothalamic,

pituitary,

adrenal axis

hypothalamic,

pituitary,

adrenal axis

.PROINFLAMMATORY CYTOKINES

.PREDOMINANTLY INTERLEUKIN-1

.TUMOR NECROSIS FACTOR/cortisolcortisol

anti,insulin

hormones

anti,insulin

hormones

insulin resistance


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3iagnostic Criteria for Sepsis

eneral variables *ever 4core te!perature 538.36,7 ypother!ia 4core te!perature 3:6,7 eart rate 590 ;!in or 52 a!!atory variables eu@ocytosis 4C, count 512D000 ;!!37 eu@openia 4C, count 000 ;!!37 )or!al C, count %ith 510E i!!ature "or!s Flas!a ,-reactive protein 52


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Impaired gl'cose tolerance (IGT) and impaired

fasting gl'cose (IFG)

The categories of */+ values are as follo-s.

• */+ B8:: mg;dl $(43 mmol;l% C normal fasting glucose

• */+ 8::E82( mg;dl $(43E34F mmol;l% C !*+ $impaired fasting glucose%

• */+ G823 mg;dl $94: mmol;l% C provisional diagnosis of diabetes $the

diagnosis must be confirmed& as described belo-%4

The categories -hen the 1+TT is used are the follo-ing.

• 2,h postload glucose B8=: mg;dl $94 mmol;l% C normal glucose

tolerance

• 2,h postload glucose 8=:E8FF mg;dl $94E8848 mmol;l% C !+T $impaired

glucose tolerance%• 2,h postload glucose G2:: mg;dl $8848 mmol;l% C provisional diagnosis of

diabetes $the diagnosis must be confirmed& as described belo-%4


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/"H0 !! score /"H0 !! score


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Definition According to the American College of Chest Physicians and the Society of Critical Care Medicine thereare different levels of sepsis:

• %ystemic inflammatory response syndrome $S!'S%4 Defined by the presenceof t-o or more of the follo-ing findings.

E *ody temperat're + , . (/0 .F) or 1 ,2 . (344 .F) (5ypot5ermia or fever )6 E Heart rate 1 344 beats per min'te (tac5ycardia)6 E !espiratory rate 1 74 breat5s per min'te or8 on blood gas8 a Pa97 less t5an ,7

mm Hg (:6, kPa) (tac5ypnea or 5ypocapnia d'e to 5yperventilation)6 E ;5ite blood cell co'nt + :8444 cells


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pache !!


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Sofa Score


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2nd Journal Reading

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