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Stress Hyperglycemia Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis.

Published version
Peer-reviewed

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Authors

Yang, Xinmin 
Zhang, Ruwen 
Jin, Tao 
Zhu, Ping 
Yao, Linbo 

Abstract

BACKGROUND/AIMS: Stress hyperglycemia is common in critical illness but it has not been clearly studied in patients with acute pancreatitis (AP). This study aimed to investigate the specific blood glucose (BG) level that defines stress hyperglycemia and to determine the impact of stress hyperglycemia on clinical outcomes in AP patients. METHODS: AP patients admitted ≤ 48 h after abdominal pain onset were retrospectively analyzed. Patients were stratified by pre-existing diabetes and stress hyperglycemia was defined using stratified BG levels for non-diabetes and diabetes with clinical outcomes compared. RESULTS: There were 967 non-diabetic and 114 diabetic (10.5%) patients met the inclusion criteria and the clinical outcomes between these two groups were not significantly different. In non-diabetes, the cut-off BG level of ≥ 180 mg/dl was selected to define stress hyperglycemia with an 8.8-fold higher odds ratio for persistent organ failure (POF) (95% CI 5.4-14.3; P < 0.001). For diabetes, ≥ 300 mg/dl was selected with a 7.5-fold higher odds ratio for POF (95% CI 1.7-34.3; P = 0.009). In multivariable logistic regression, stress hyperglycemia was independently associated with POF, acute necrotic collection, major infection and mortality. The combination of BG and systemic inflammatory response syndrome (SIRS) score in predicting POF was better than SIRS or Glasgow score alone. CONCLUSIONS: This study identifies a cut-off BG level of ≥ 180 mg/dl and ≥ 300 mg/dl was optimal to define stress hyperglycemia for non-diabetic and diabetic AP patients, respectively. There was a significant relationship between stress hyperglycemia and adverse clinical outcomes.

Description

Keywords

Acute pancreatitis, Blood glucose, Diabetes mellitus, Persistent organ failure, Receiver operating characteristic curve, Stress hyperglycemia, Acute Disease, Blood Glucose, Diabetes Mellitus, Humans, Hyperglycemia, Pancreatitis, Retrospective Studies, Systemic Inflammatory Response Syndrome

Journal Title

Dig Dis Sci

Conference Name

Journal ISSN

0163-2116
1573-2568

Volume Title

67

Publisher

Springer Science and Business Media LLC
Sponsorship
NZ-China Strategic Research Alliance (2016YFE0101800)
National Natural Science Foundation of China (81973632, 81774120, 81800575)