Study on the value of blood glucose variability indexes in predicting persistent organ failure after acute pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHEN Yuxin , HE Yanqiu , CHEN Zhiyao , CAI Fei , HU Cheng , XIA Qing ,  DENG Lihui

1. West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine , West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

DENG Lihui, Email: denglihui@scu.edu.cn

Keywords：

acute pancreatitis; blood glucose variability index; persistent organ failure; severe acute pancreatitis

DOI：

10.7507/1007-9424.202312031

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the relationship between blood glucose variability index and persistent organ failure (POF) in acute pancreatitis (AP). Methods We prospectively included those patients who were diagnosed with AP with hyperglycemia and were hospitalized in the West China Center of Excellence for Pancreatitis of West China Hospital of Sichuan University from July 2019 to November 2021. The patients were given blood glucose monitoring at least 4 times a day for at least 3 consecutive days. The predictive value of blood glucose variability index for POF in patients with AP was analyzed. Results A total of 559 patients with AP were included, including 95 cases of POF. Comparing with those without POF, patients with AP complicated by POF had higher levels of admission glucose (11.0 mmol/L vs. 9.6 mmol/L), minimum blood glucose (6.8 mmol/L vs. 5.8 mmol/L), mean blood glucose (9.6 mmol/L vs. 8.7 mmol/L), and lower level of coefficient of variation of blood glucose (16.6 % vs. 19.0 %), P<0.05. Logistic regression analyses after adjustment for confounding factors showed that the risk of POF increased with the increase of admission glucose [OR=1.11, 95%CI (1.04, 1.19), P=0.002], minimum blood glucose [OR=1.28, 95%CI (1.10, 1.48), P=0.001] and mean blood glucose [OR=1.18, 95%CI (1.04, 1.33), P=0.010]; with the higher level of coefficient of variation of blood glucose [OR=0.95, 95%CI (0.92, 0.99), P=0.021], the risk of POF decreased. The results of area under the curve (AUC) of the receiver operator curves showed that AG [AUC=0.787, 95%CI (0.735, 0.840)] had the highest accuracy in predicting POF, with sensitivities of 60.0% and specificities of 84.7%. Conclusion High admission glucose, minimum blood glucose, mean blood glucose, and low coefficient of variation of blood glucose were risk factors for the development of POF in patients with hyperglycemic AP on admission.

Citation： SHEN Yuxin, HE Yanqiu, CHEN Zhiyao, CAI Fei, HU Cheng, XIA Qing, DENG Lihui. Study on the value of blood glucose variability indexes in predicting persistent organ failure after acute pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(2): 169-174. doi: 10.7507/1007-9424.202312031 Copy

1.	Boxhoorn L, Voermans RP, Bouwense SA, et al. Acute pancreatitis. Lancet, 2020, 396(10252): 726-734.
2.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
3.	Dellinger EP, Forsmark CE, Layer P, et al. Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation. Ann Surg, 2012, 256(6): 875-880.
4.	Wu LM, Sankaran SJ, Plank LD, et al. Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis. Br J Surg, 2014, 101(13): 1644-1656.
5.	Van Cromphaut SJ. Hyperglycaemia as part of the stress response: the underlying mechanisms. Best Pract Res Clin Anaesthesiol, 2009, 23(4): 375-386.
6.	Müller-Graff FT, Fitzner B, Jaster R, et al. Impact of hyperglycemia on autoimmune pancreatitis and regulatory T-cells. World J Gastroenterol, 2018, 24(28): 3120-3129.
7.	Brinati LM, de Fátima Januário C, Balbino PC, et al. Incidence and prediction of unstable blood glucose level among critically ill patients: a cohort study. Int J Nurs Knowl, 2021, 32(2): 96-102.
8.	Krinsley JS, Preiser JC. Is it time to abandon glucose control in critically ill adult patients? Curr Opin Crit Care, 2019, 25(4): 299-306.
9.	Hu N, Zhang X, Zhang X, et al. Inhibition of Notch activity suppresses hyperglycemia-augmented polarization of macrophages to the M1 phenotype and alleviates acute pancreatitis. Clin Sci (Lond), 2022, 136(7): 455-471.
10.	Yang X, Zhang R, Jin T, et al. Stress hyperglycemia is independently associated with persistent organ failure in acute pancreatitis. Dig Dis Sci, 2022, 67(5): 1879-1889.
11.	Yang X, Shi N, Yao L, et al. Impact of admission and early persistent stress hyperglycaemia on clinical outcomes in acute pancreatitis. Front Endocrinol (Lausanne), 2022, 13: 998499. doi: 10.3389/fendo.2022.998499.
12.	Czakó L, Hegyi P, Rakonczay Z Jr, et al. Interactions between the endocrine and exocrine pancreas and their clinical relevance. Pancreatology, 2009, 9(4): 351-359.
13.	Frontoni S, Di Bartolo P, Avogaro A, et al. Glucose variability: an emerging target for the treatment of diabetes mellitus. Diabetes Res Clin Pract, 2013, 102(2): 86-95.
14.	American Diabetes Association. Standards of medical care in diabetes-2022. Diabetes Care, 2022, 45(Suppl 1): S1-S264.
15.	Suh S, Kim JH. Glycemic variability: how do we measure it and why is it important? Diabetes Metab J, 2015, 39(4): 273-282.
16.	Rodbard D. Hypo- and hyperglycemia in relation to the mean, standard deviation, coefficient of variation, and nature of the glucose distribution. Diabetes Technol Ther, 2012, 14(10): 868-876.
17.	Machicado JD, Gougol A, Tan X, et al. Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected. United European Gastroenterol J, 2021, 9(2): 139-149.
18.	Chen J, Wan J, Shu W, et al. Association of serum levels of silent information regulator 1 with persistent organ failure in acute pancreatitis. Dig Dis Sci, 2019, 64(11): 3173-3181.
19.	Lu Y, Zhang Q, Lou J. Blood glucose-related indicators are associated with in-hospital mortality in critically ill patients with acute pancreatitis. Sci Rep, 2021, 11(1): 15351. doi: 10.1038/s41598-021-94697-1.
20.	Sun YF, Song Y, Liu CS, et al. Correlation between the glucose level and the development of acute pancreatitis. Saudi J Biol Sci, 2019, 26(2): 427-430.
21.	Nagy A, Juhász MF, Görbe A, et al. Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: post-hoc analysis of a prospective, international cohort of 2 250 acute pancreatitis cases. Pancreatology, 2021, 21(7): 1237-1246.
22.	Jivanji CJ, Asrani VM, Pendharkar SA, et al. Glucose variability measures as predictors of oral feeding intolerance in acute pancreatitis: a prospective pilot study. Dig Dis Sci, 2017, 62(5): 1334-1345.
23.	Leung PS, Chan YC. Role of oxidative stress in pancreatic inflammation. Antioxid Redox Signal, 2009, 11(1): 135-165.
24.	Stehouwer CDA. Microvascular dysfunction and hyperglycemia: a vicious cycle with widespread consequences. Diabetes, 2018, 67(9): 1729-1741.
25.	Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA, 2006, 295(14): 1681-1687.
26.	Boonen E, Van den Berghe G. Endocrine responses to critical illness: novel insights and therapeutic implications. J Clin Endocrinol Metab, 2014, 99(5): 1569-1582.
27.	Zhang H, Li L, Wu J, et al. Enteral nutrition preparations for blood glucose variability and prognosis for severe acute pancreatitis with stress hyperglycemia. Altern Ther Health Med, 2023, 29(1): 163-169.

1. Boxhoorn L, Voermans RP, Bouwense SA, et al. Acute pancreatitis. Lancet, 2020, 396(10252): 726-734.
2. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
3. Dellinger EP, Forsmark CE, Layer P, et al. Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation. Ann Surg, 2012, 256(6): 875-880.
4. Wu LM, Sankaran SJ, Plank LD, et al. Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis. Br J Surg, 2014, 101(13): 1644-1656.
5. Van Cromphaut SJ. Hyperglycaemia as part of the stress response: the underlying mechanisms. Best Pract Res Clin Anaesthesiol, 2009, 23(4): 375-386.
6. Müller-Graff FT, Fitzner B, Jaster R, et al. Impact of hyperglycemia on autoimmune pancreatitis and regulatory T-cells. World J Gastroenterol, 2018, 24(28): 3120-3129.
7. Brinati LM, de Fátima Januário C, Balbino PC, et al. Incidence and prediction of unstable blood glucose level among critically ill patients: a cohort study. Int J Nurs Knowl, 2021, 32(2): 96-102.
8. Krinsley JS, Preiser JC. Is it time to abandon glucose control in critically ill adult patients? Curr Opin Crit Care, 2019, 25(4): 299-306.
9. Hu N, Zhang X, Zhang X, et al. Inhibition of Notch activity suppresses hyperglycemia-augmented polarization of macrophages to the M1 phenotype and alleviates acute pancreatitis. Clin Sci (Lond), 2022, 136(7): 455-471.
10. Yang X, Zhang R, Jin T, et al. Stress hyperglycemia is independently associated with persistent organ failure in acute pancreatitis. Dig Dis Sci, 2022, 67(5): 1879-1889.
11. Yang X, Shi N, Yao L, et al. Impact of admission and early persistent stress hyperglycaemia on clinical outcomes in acute pancreatitis. Front Endocrinol (Lausanne), 2022, 13: 998499. doi: 10.3389/fendo.2022.998499.
12. Czakó L, Hegyi P, Rakonczay Z Jr, et al. Interactions between the endocrine and exocrine pancreas and their clinical relevance. Pancreatology, 2009, 9(4): 351-359.
13. Frontoni S, Di Bartolo P, Avogaro A, et al. Glucose variability: an emerging target for the treatment of diabetes mellitus. Diabetes Res Clin Pract, 2013, 102(2): 86-95.
14. American Diabetes Association. Standards of medical care in diabetes-2022. Diabetes Care, 2022, 45(Suppl 1): S1-S264.
15. Suh S, Kim JH. Glycemic variability: how do we measure it and why is it important? Diabetes Metab J, 2015, 39(4): 273-282.
16. Rodbard D. Hypo- and hyperglycemia in relation to the mean, standard deviation, coefficient of variation, and nature of the glucose distribution. Diabetes Technol Ther, 2012, 14(10): 868-876.
17. Machicado JD, Gougol A, Tan X, et al. Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected. United European Gastroenterol J, 2021, 9(2): 139-149.
18. Chen J, Wan J, Shu W, et al. Association of serum levels of silent information regulator 1 with persistent organ failure in acute pancreatitis. Dig Dis Sci, 2019, 64(11): 3173-3181.
19. Lu Y, Zhang Q, Lou J. Blood glucose-related indicators are associated with in-hospital mortality in critically ill patients with acute pancreatitis. Sci Rep, 2021, 11(1): 15351. doi: 10.1038/s41598-021-94697-1.
20. Sun YF, Song Y, Liu CS, et al. Correlation between the glucose level and the development of acute pancreatitis. Saudi J Biol Sci, 2019, 26(2): 427-430.
21. Nagy A, Juhász MF, Görbe A, et al. Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: post-hoc analysis of a prospective, international cohort of 2 250 acute pancreatitis cases. Pancreatology, 2021, 21(7): 1237-1246.
22. Jivanji CJ, Asrani VM, Pendharkar SA, et al. Glucose variability measures as predictors of oral feeding intolerance in acute pancreatitis: a prospective pilot study. Dig Dis Sci, 2017, 62(5): 1334-1345.
23. Leung PS, Chan YC. Role of oxidative stress in pancreatic inflammation. Antioxid Redox Signal, 2009, 11(1): 135-165.
24. Stehouwer CDA. Microvascular dysfunction and hyperglycemia: a vicious cycle with widespread consequences. Diabetes, 2018, 67(9): 1729-1741.
25. Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA, 2006, 295(14): 1681-1687.
26. Boonen E, Van den Berghe G. Endocrine responses to critical illness: novel insights and therapeutic implications. J Clin Endocrinol Metab, 2014, 99(5): 1569-1582.
27. Zhang H, Li L, Wu J, et al. Enteral nutrition preparations for blood glucose variability and prognosis for severe acute pancreatitis with stress hyperglycemia. Altern Ther Health Med, 2023, 29(1): 163-169.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study on the value of blood glucose variability indexes in predicting persistent organ failure after acute pancreatitis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content