Stress Hyperglycemia In Patients Research Articles

Long-term prognostic significance of stress hyperglycemia in patients with ST-elevation myocardial infarction

Abstract Funding Acknowledgements None. Background/aim Stress hyperglycemia is defined as hyperglycemia that occurs in critically ill patients without diabetes mellitus (DM). It is associated with adverse in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI). The aim of the present study is to evaluate short- and long-term prognostic impact of stress hyperglycemia in STEMI patients. Method We analysed 2505 consecutive STEMI patients treated with successful primary PCI (pPCI) without previous DM and without cardiogenic shock at admission. Successful pPCI was defined as post-procedural flow TIMI 3. Stress hyperglycemia was defined as plasma glucose level above 7.8mmol/L at any time during hospitalization. The follow-up period was 6 years. Results Stress hyperglycemia at admission was registered in 685 (27.3%) patients. Compared with patients without stress hyperglycemia, patients with stress hyperglycemia were older and presented more often with heart failure (Killip class II and III); they were more likely to have hypertension, chronic kidney disease, three vessel coronary disease (at initial angiogram) and lower predischarge left ventricular ejection fraction (EF). In-hospital, 30-day and 6-year mortality were significantly higher in patients with stress hyperglycemia vs patients without stress hyperglycemia: 7.1% vs 1.5%, 7.5% vs 1.7% and 12.5% vs 4.6% (p<0.001), respectively as shown in Figure 1. In Cox regression analysis stress hyperglycemia was an independent predictor for in-hospital, 30-days and 6-year mortality- HR 2.19 (95% 1.49-3.94), p=0.018, HR 1,58(95%CI 1.15-2.85), p=0.020 and HR 1.52 (95%CI 1.32-2.17), p=0.030, respectively. Conclusion In STEMI patients without diabetes mellitus treated with successful primary PCI stress hyperglycemia is an independent predictor for short- and long-term mortality (up to 6-years). These findings emphasize the importance of close monitoring of blood glucose level in STEMI patients regardless of diabetic status.

154-OR: Metabolomics Analysis Reveals Links between Stress Hyperglycemia and Underlying Differences in Branched-Chain Amino-Acid Metabolism and Microbiome–Host Interactions

The mechanisms that lead to stress-hyperglycemia are poorly understood. We examined metabolic signatures associated with stress-hyperglycemia in patients without diabetes undergoing cardiac surgery. We enrolled patients without diabetes [BG ≤125mg/dl and HbA1c<6.5%] undergoing CABG surgery and compared those with stress hyperglycemia (“High”, mean glucose >140 or glucose >180mg/dl) vs those with preserved glucose metabolism (“Low”). Utilizing untargeted LCMS-derived high-resolution metabolomics (HRM) analysis we examined metabolites and metabolic pathways associated with incident stress hyperglycemia. Metabolic pathways were identified from HILIC positive and Reverse Phase C18 analysis, with metabolites mapped to Kyoto Encyclopedia of Genes and Genomes (KEGG) human pathways. A total of 36 patients (age: 62.7 years, 83% male, HbA1c 5.5%) underwent CABG surgery. Nine patients developed stress hyperglycemia immediately after starting surgery and showed differences in branched-chain amino acids (BCAA, e.g., methyl-oxopentanoate), lipid metabolism (e.g., diacylglycerols), and microbiome metabolism (e.g., linoleate), figure. This analysis reveals links between stress-hyperglycemia and BCAA, and lipid metabolism, and microbiome-host interactions among nondiabetic patients undergoing cardiac stress. Disclosure A. Abraham: None. M.R. Smith: None. M. Perez-Guzman: None. F. Zahedi Tajrishi: None. L.I. Guerrero Arroyo: None. A. Chakragiri: None. J. Varghese: None. F.J. Pasquel: Consultant; Dexcom, Inc., Medscape. Research Support; Dexcom, Inc., Ideal Medical Technologies. Funding National Institutes of Health (K23GM128221)

Prognostic implication of stress hyperglycemia in patients with acute coronary syndrome undergoing percutaneous coronary intervention

BackgroundIt is now understood that stress hyperglycemia is associated with adverse outcomes in hospitalized patients. Herein, we aimed to investigate the association between stress hyperglycemia and mortality risk in acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI).MethodsThis cohort study comprised 5190 ACS patients who underwent PCI from the Cardiovascular Center Beijing Friendship Hospital Database Bank (CBDBANK) from January 2013 to January 2021. Stress hyperglycemia was defined by the glucose/glycated albumin (GA) ratio, calculated as admission fasting plasma glucose divided by GA. The patients were divided into four groups according to glucose/GA ratio quartiles (Q1-Q4). Cox proportional hazards regression and restricted cubic spline were used to evaluate the association between glucose/GA ratio and all-cause and cardiovascular mortality.ResultsDuring a median follow-up of 4.0 years, the number of all-cause deaths was 313 (6.0%) and cardiovascular-associated deaths was 177 (3.4%). After adjustment for potential confounders, the risk of all-cause mortality increased in the lowest (HR, 1.43; 95% CI, 1.01–2.03) and highest (HR, 1.51; 95% CI, 1.03–2.21) glucose/GA ratio quartiles compared to Q2. The restricted cubic splines showed that the association between glucose/GA ratio and all-cause mortality was U-shaped after full adjustment (Pnonlinear = 0.008). Similar results were observed for cardiovascular mortality. In subgroup analyses according to diabetes status, the U-shaped relationship was only significant in patients with diabetes mellitus.ConclusionIn ACS patients undergoing PCI, low and high glucose/GA ratio values were associated with an increased all-cause and cardiovascular mortality, especially in those with diabetes mellitus.

The association between neutrophil counts and neutrophil-to-lymphocyte ratio and stress hyperglycemia in patients with acute ischemic stroke according to stroke etiology.

Stress hyperglycemia ratio (SHR), which is used to assess stress hyperglycemia, is associated with the functional outcome of ischemic stroke (IS). IS can induce the inflammatory response. Neutrophil counts and neutrophil-to-lymphocyte ratio (NLR) as good and easily available inflammatory biomarkers, the relationship between neutrophil counts and NLR and SHR were poorly explored in IS. We aimed to systemically and comprehensively explore the correlation between various blood inflammation markers (mainly neutrophil counts and NLR) and SHR. Data from 487 patients with acute IS(AIS) in Xiangya Hospital were retrospectively reviewed. High/low SHR groups according to the median of SHR (≤1.02 versus >1.02). Binary logistic regression analysis was used to evaluate the correlation between neutrophil counts and NLR and high SHR group. Subgroup analyses were performed in the TOAST classification and functional prognosis. The neutrophil counts and NLR were all clearly associated with SHR levels in different logistic analysis models. In the subgroup analysis of TOAST classification, the higher neutrophil counts and NLR were the independent risk factors for high SHR patients with large-artery atherosclerosis (LAA) (neutrophil: adjusted OR:2.047, 95% CI: 1.355-3.093, P=0.001; NLR: adjusted OR:1.315, 95% CI: 1.129-1.530, P<0.001). The higher neutrophil counts were the independent risk factor for high SHR patients with cardioembolism (CE) (adjusted OR:2.413, 95% CI: 1.081-5.383, P=0.031). ROC analysis showed that neutrophil counts was helpful for differentiating high SHR group with CE and low SHR group with CE (neutrophil: AUC =0.776, P=0.002). However, there were no difference in levels of neutrophil counts and NLR between patients with SVO and without SVO. The higher neutrophil counts and NLR independently associated with high SHR patients with mRS ≤2 at 90 days from symptom onset, (neutrophil: adjusted OR:2.284, 95% CI: 1.525-3.420, P<0.001; NLR: adjusted OR:1.377, 95% CI: 1.164-1.629, P<0.001), but not in patients with mRS >2. This study found that the neutrophil counts and NLR are positively associated with SHR levels in AIS patients. In addition, the correlation between neutrophil counts and NLR and different SHR levels are diverse according to TOAST classification and functional prognosis.

#1323518: Metabolomics Analysis Reveals Links Between Stress-Hyperglycemia and Endothelial Cell Activation and Altered Microbiome-Host Interactions During Cardiac Stress

The underlying mechanisms leading to stress-hyperglycemia and its association with poor outcomes in cardiac surgery patients are not well understood. We aimed to identify metabolic signatures associated with stress-hyperglycemia in patients with atherosclerotic cardiovascular disease (ASCVD) undergoing coronary artery bypass-graft (CABG) surgery.

Relationship between cytokine release and stress hyperglycemia in patients hospitalized with COVID-19 infection.

IntroductionStress hyperglycemia is a frequent finding in patients with COVID-19 infection and could affect the outcome of disease. Cytokines released in response to infection could have adverse effects on insulin sensitivity and pancreatic beta-cell function. The aim of the study was to examine the relationships of stress hyperglycemia with cytokines and clinical outcomes in hospitalized patients with COVID-19.MethodsIn a cross-sectional analysis of 150 patients hospitalized for COVID-19 infection who were included in the GIRA-COVID database, we identified patients with stress hyperglycemia by calculation of the Stress Hyperglycemia Ratio (SHR) and use of a cut-off of 1.14. Plasma levels of cytokines principally involved in COVID-19 infection-related cytokine storm were measured. Outcome variables were use of mechanical ventilation and death within 60 days from hospital admission.ResultsPatients with SHR > 1.14 had significantly higher plasma insulin, HOMA-index, and levels of interleukin-10 (IL-10), interleukin-10/tumor necrosis factor-a ratio (IL-10/TNF-α), and CXC motif chemokine ligand 10 (CXCL10) than patients with SHR ≤ 1.14. IL-10, IL-10/TNF-α ratio, CXCL10, and IFN-γ were significantly and directly related with SHR in univariate analysis and multivariate logistic regression models showed that IL-10, IL-10/TNF-α ratio, and CXCL10 were independently associated with SHR>1.14. In a multivariate logistic model, stress hyperglycemia predicted use of mechanical ventilation (OR 2.453; CI 1.078–6.012) and death (OR 2.281; CI 1.049–7.369) independently of diabetes and other major confounders.ConclusionsIn patients hospitalized for COVID-19 infection, stress hyperglycemia is associated with worse clinical outcomes and is independently related to levels of cytokines that might impair glucose homeostasis.

Prognostic Value of Stress Hyperglycemia in Patients Admitted to Medical/Geriatric Departments for Acute Medical Illness.

IntroductionHyperglycemia is common in patients admitted to Italian medical/geriatric units and is associated with a poorer outcome. We tested the significance of diabetes and stress-induced hyperglycemia in clinical outcome.Materials and MethodsThree hundred seventy-eight consecutive patients with hyperglycemia at entry (≥ 126 mg/dl) (206 without known diabetes) were included, with a wide range of underlying diseases requiring hospital admission and independent of the presence of diabetes. Relative hyperglycemia was calculated as admission glucose divided by average glucose, estimated based of glycosylated hemoglobin. Values ≥ 1.20 were considered indicative of stress hyperglycemia (SHR). The association of SHR with outcome variables (all-cause complications, infections, non-infectious events, deaths) was tested by logistic regression analysis, adjusted for sex, BMI, age-adjusted comorbidities (Charlson index) and known diabetes.ResultsDuring hospital stay, one or more events were registered in 96 patients (25.4%); 44 patients died in hospital, and fatality rate was borderline higher in patients without diabetes (14.6% vs. 8.1% in diabetes; P = 0.052) and nearly three times higher in patients with stress hyperglycemia (15.0%) vs. those with SHR < 1.2 (P = 0.005). Stress hyperglycemia—more common in the absence of diabetes (71% vs. 58%)—and age were the only independent prognostic factors for death. At multivariable analysis, the risks of death (OR 4.31, 95% CI 1.25–14.81), of all complications (OR 5.90, 95% CI 2.22–15.71) and of newly developed systemic infections (OR 5.67, 95% CI 1.61–19.92) were associated with stress hyperglycemia in subjects without diabetes, as was the risk in non-insulin-treated cases (OR 4.02, 95% CI 1.16–13.92; OR 5.47, 95% CI 2.21–13.52; OR 5.15, 95% CI 1.70–15.62, respectively).ConclusionThe study confirms the prognostic value of stress-related hyperglycemia in patients requiring hospital admission to a geriatric/medical unit for a variety of acute medical conditions, contributing to adverse outcomes not limited to events commonly associated with hyperglycemia (e.g., infections).Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01183-y.

Stress Hyperglycemia in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Undergoing Mechanical Thrombectomy.

Stress hyperglycemia may impair outcomes in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). The glucose-to-glycated hemoglobin ratio (GAR) was used to measure stress hyperglycemia. Data from our database of consecutive patients admitted to the Udine University Hospital with AIS who were treated with MT between January 2015 and December 2020 were retrospectively analyzed. We included 204 patients in the study and stratified them into four groups according to the quartiles of GAR (Q1–Q4). The higher the GAR index, the more severe the stress hyperglycemia was considered. Patients with more severe stress hyperglycemia showed a higher prevalence of 3-month poor outcome (Q1, 53.1%; Q2, 40.4%; Q3, 63.5%; Q4, 82.4%; p = 0.001), 3-month mortality (Q1, 14.3%; Q2, 11.5%; Q3, 15.4%; Q4, 31.4%; p = 0.001), and symptomatic intracranial hemorrhage (Q1, 2%; Q2, 7.7%; Q3, 7.7%; Q4, 25.4%; p = 0.001). After controlling for several confounders, severe stress hyperglycemia remained a significant predictor of 3-month poor outcome (OR 4.52, 95% CI 1.4–14.62, p = 0.012), 3-month mortality (OR 3.55, 95% CI 1.02–12.29, p = 0.046), and symptomatic intracranial hemorrhage (OR 6.89, 95% CI 1.87–25.36, p = 0.004). In summary, stress hyperglycemia, as measured by the GAR index, is associated with a detrimental effect in patients with AIS undergoing MT.

FREQUENCY OF STRESS HYPERGLYCEMIA AND MORTALITY IN PATIENTS WITH HYPERGLYCEMIA IN MEDICAL INTENSIVE CARE UNIT

Objective: To assess the frequency of stress hyperglycemia and mortality in patients with hyperglycemia admitted in medical Intensive Care Unit.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Medical Intensive Care Unit, Combined Military Hospital Quetta, from Nov 2018 to Jun 2019.&#x0D; Methodology: A total of 150 adult patients of age between 18-80 years, of both genders, with Intensive Care Unit stay &gt;24 hours, who were treated in medical Intensive Care Unit during study period, were included in the study. Those patients with duration of stay &lt;24 hours, paediatric patients, surgical and pregnant patients and those who were on chronic steroid therapy and those who were given TPN and dextrose infusions were excluded. The blood sugar fasting was measured daily and blood sugar random was measured on admission and twice daily. The patients were segregated into three groups: Normoglycemia, Diabetes mellitus and Stress hyperglycaemia. The frequency of patients and outcome of patients in terms of death was observed in all groups.&#x0D; Results: The mean age of study population was 55.02 ± 18.14 years, with 99 (66%) were males while 51 (34%) were females. Among study population 77 (51.3%) had normoglycemia, 46 (30.7%) had Diabetes Mellitus while 27 (18%) had stress hyperglycaemia. Out of 77 patients with normoglycemia 10 (12.9%) died, while number of deaths in patients with diabetes mellitus and stress hyperglycaemia was 21 (45.6%) and 15 (55.5%) respectively. The mean maximum blood glucose in those who survived and died was 214.39 ± 100.69 mg/dl and 295.26 ± 122.60................

Stress Hyperglycaemia Indicates Embolus Size and Localization in Patients with Acute Pulmonary Embolism.

Objective Acute pulmonary embolism is a life-threatening form of venous thromboembolism often causing stress hyperglycaemia. The aim of this study was to determine the prognostic value of stress hyperglycaemia in acute pulmonary embolism, providing new insights into the presumed embolus size and localization, clinical parameters (Pulmonary Embolism Severity Index, PESI), and in-hospital mortality. Design and Methods. Among a total of 95,454 patients referred to the Emergency Department of the Sestre Milosrdnice University Hospital Centre between 2014 and 2016, all patients with acute pulmonary embolism were included into this observational cohort study. The study group consisted of 190 patients aged 25–96. Relevant patient history, clinical data, and laboratory findings were collected during the entire hospitalization period. Data were analyzed for the entire group of patients, as well as separately for patients without diabetes, using the Fisher exact test and logistic regression. Results Analysis of embolus localization as an indirect parameter of embolus size showed that patients with stress hyperglycaemia more often had emboli located in proximal parts of the pulmonary circulation (i.e., main artery or lobar branches) (p < 0.05). Furthermore, stress hyperglycaemia correlated with PESI score and diabetes (p < 0.05) in the entire patient group. Stress hyperglycaemia showed independent association with in-hospital mortality in patients (p < 0.05). Conclusion Stress hyperglycaemia in patients with acute pulmonary embolism is associated with embolus localization in larger arteries of the pulmonary circulation and higher PESI score and therefore could serve as an independent in-hospital mortality predictor.

Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis.

Objectives:Poor glycemic control is associated with mortality in critical patients with diabetes. The aim of the study was to assess the predicting value of stress hyperglycemia in patients with diabetes following hospital admission for sepsis.Design:Retrospective observational study.Setting:Adult, emergency department, and critical care in a district hospital.Patients:In a 10-year retrospective analysis of sepsis-related hospitalizations in the emergency department, we carried out a secondary analysis of 915 patients with diabetes (males, 54.0%) in whom both fasting glucose at entry and glycosylated hemoglobin were available.Interventions:None.Measurements and Main Results:Patients’ mean age was 79.0 (sd 11.0), glucose at admission was 174.0 mg/dL (74.3 mg/dL), and glycosylated hemoglobin was 7.7% (1.7%). Stress hyperglycemia was defined by the stress hyperglycemia ratio, that is, fasting glucose concentration at admission divided by the estimated average glucose derived from glycosylated hemoglobin. A total of 305 patients died (33.3%) in hospital. Factors associated with in-hospital case fatality rate were tested by multivariable logistic model. Ten variables predicting outcomes in the general population were confirmed in the presence of diabetes (male sex, older age, number of organ dysfunction diagnoses, in particular cardiovascular dysfunction, infection/parasitic, circulatory, respiratory, digestive diseases diagnosis, and Charlson Comorbidity Index). In addition, also glycemic control (glycosylated hemoglobin: odds ratio, 1.17; 95% CI, 1.15–1.40) and stress hyperglycemia (stress hyperglycemia ratio: 5.25; 3.62–7.63) were significant case fatality rate predictors. High stress hyperglycemia ratio (≥ 1.14) significantly increased the discriminant capacity (area under the receiver operating characteristic curve, 0.864; se, 0.013; p < 0.001).Conclusions:Stress hyperglycemia, even in the presence of diabetes, is predictive of mortality following admission for sepsis. Stress hyperglycemia ratio may be used to refine prediction of an unfavorable outcome.

1508-P: Predicting Stress Hyperglycemia in Patients without Diabetes Admitted to the Hospital

Stress hyperglycemia (SH) is associated with poor clinical outcomes in hospitalized patients. Delays in recognizing SH impact timing of treatment, however, the best way to identify those at risk is unclear. We assessed the value of a validated diabetes risk test, the Cambridge Risk Score (CRS), to predict SH in patients admitted to the hospital compared to using undiagnosed diabetes and prediabetes based on HbA1c. Adults admitted without diabetes or use of diabetes medication to medical and surgical services of an academic hospital over 4 years was analyzed. Patients with at least one measurement of blood glucose ≥ 140mg/dL during the stay were identified as having SH. CRS was calculated using age, sex, BMI, family history of diabetes, smoking status, and use of antihypertensives or steroids. Prediabetes was defined based on HbA1c 5.7-6.4 and undiagnosed diabetes was defined as HbA1c &amp;gt;=6.5 without ICD code of diabetes in the medical record. Multivariate regression was used to assess the association between CRS, prediabetes and undiagnosed diabetes, and risk of SH controlling for relevant covariates. 5,535 adults met inclusion criteria, 25.9% developed SH. CRS as a continuous variable was significantly associated with risk of SH after adjustment (OR 2.25, 1.84 - 2.74). Prediabetes was significantly associated with risk of SH after adjustment (OR 1.31, 1.13-1.51). However, undiagnosed diabetes was not significantly associated with SH, but many individuals were missing A1c measures which could have influenced results. In conclusion results of this study suggest CRS risk stratification and early assessment for prediabetes may allow early identification of individuals at risk for SH. Disclosure C.E. Mendez: Advisory Panel; Self; Monarch Medical Technologies. R.J. Walker: None. K. Lu: None. A.Z. Dawson: None. L.E. Egede: None.

Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Background:Stress hyperglycemia is a common finding during ST elevation myocardial infarction in diabetic patients and is associated with a worse outcome. However, there are limited data about stress hyperglycemia in non-diabetic patients and its outcome especially in patients undergoing primary percutaneous coronary intervention.Methods:The study was conducted on 660 patients with ST elevation myocardial infarction who were managed with primary percutaneous coronary intervention. Patients were classified into two groups according to the presence of stress hyperglycemia: group I (patients with stress hyperglycemia) and group II (patients without stress hyperglycemia). Patients were analysed for clinical outcome including mortality and the occurrence of major adverse cardiac events.Results:Incidence of stress hyperglycemia was 16.8%, multivariate regression analysis identified the independent predictors of stress hyperglycemia, that were family history of diabetes mellitus odds ratio 1.697 (95% confidence interval: 1.077–2.674, p = 0.023), body mass index >24 kg/m2 odds ratio 1.906 (95% confidence interval: 1.244–2.922, p = 0.003) and cardiogenic shock on admission odds ratio 2.517 (95% confidence interval: 1.162–5.451, p = 0.019). Mortality, cardiogenic shock, contrast induced nephropathy and no reflow phenomenon were significantly higher in stress hyperglycemia group with p value = 0.027, 0.001, 0.020 and 0.037, respectively.Conclusion:Stress hyperglycemia in non-diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with increased incidence of no reflow phenomenon, contrast induced nephropathy, cardiogenic shock and higher mortality.

Sitagliptin for the prevention of stress hyperglycemia in patients without diabetes undergoing coronary artery bypass graft (CABG) surgery

AimsTo determine if treatment with sitagliptin, a dipeptidyl peptidase-4 inhibitor, can prevent stress hyperglycemia in patients without diabetes undergoing coronary artery bypass graft (CABG) surgery.MethodsWe conducted a pilot, double-blinded, placebo-controlled...

Sitagliptin for prevention of stress hyperglycemia in patients without diabetes undergoing general surgery: A pilot randomized study

AimWe investigated if a dipeptidyl peptidase-4 inhibitor, sitagliptin, can prevent perioperative stress hyperglycemia in patients without prior history of diabetes mellitus undergoing general surgery. MethodsThis double-blind pilot trial randomized general surgery patients to receive sitagliptin (n = 44) or placebo (n = 36) once daily, starting one day prior to surgery and continued during the hospital stay. The primary outcome was occurrence of stress hyperglycemia, defined by blood glucose (BG) >140 mg/dL and >180 mg/dL after surgery. Secondary outcomes included: length-of-stay, ICU transfers, hypoglycemia, and hospital complications. ResultsBG >140 mg/dL was present in 44 (55%) of subjects following surgery. There were no differences in hyperglycemia between placebo and sitagliptin (56% vs. 55%, p = 0.93). BG >180 mg/dL was observed in 19% and 11% of patients treated with placebo and sitagliptin, respectively, p = 0.36. Both treatment groups had resulted in similar postoperative BG (148.9 ± 29.4 mg/dL vs. 146.9 ± 35.2 mg/dL, p = 0.73). There were no differences in length-of-stay (4 vs. 3 days, p = 0.84), ICU transfer (3% vs. 5%, p = 1.00), hypoglycemia <70 mg/dL (6% vs. 11%, p = 0.45), and complications (14% vs. 18%, p = 0.76). ConclusionPreoperative treatment with sitagliptin did not prevent stress hyperglycemia or complications in individuals without diabetes undergoing surgery.

Stress Hyperglycemia in Patients with Tuberculosis Disease: Epidemiology and Clinical Implications.

The intersection of tuberculosis (TB) disease and type 2 diabetes mellitus is severely hindering global efforts to reduce TB burdens. Diabetes increases the risk of developing TB disease and negatively impacts TB treatment outcomes including culture conversion time, mortality risk, and TB relapse. Recent evidence also indicates plausible mechanisms by which TB disease may influence the pathogenesis and incidence of diabetes. We review the epidemiology of stress hyperglycemia in patients with TB and the pathophysiologic responses to TB disease that are related to established mechanisms of stress hyperglycemia. We also consider clinical implications of stress hyperglycemia on TB treatment, and the role of TB disease on risk of diabetes post-TB. Among patients with TB disease, the development of stress hyperglycemia may influence the clinical manifestation and treatment response of some patients and can complicate diabetes diagnosis. Research is needed to elucidate the relationship between TB disease and stress hyperglycemia and determine the extent to which stress hyperglycemia impacts TB treatment response. Currently, there is insufficient data to support clinical recommendations for glucose control among patients with TB disease, representing a major barrier for efforts to improve treatment outcomes for patients with TB and diabetes.

P1748Should we care for stress hyperglycaemia in patients admitted with acute coronary syndromes?

P1748Should we care for stress hyperglycaemia in patients admitted with acute coronary syndromes?

Predictors of stress hyperglycemia in patients with acute phase of Q-wave myocardial infarction complicated by acute heart failure without diabetes history

The aim was to identify the predictors of stress hyperglycemia in patients with acute phase of Q-wave myocardial infarction complicated by acute heart failure without diabetes history. Materials and methods. 55 patients in acute phase of Q-wave myocardial infarction complicated by acute heart failure were examined. 38 (67 %) of them were male. The average age was 63 ± 10.6 years. Stress hyperglycemia was revealed in 32 persons on admission. The average level of glucose in patients with hyperglycemia was 9.25 ± 0.35 mmol/l, with normoglycemia – 6.05 ± 0.23 mmol/l. When constructing the multivariate linear regression model we used the data from anamnesis and body mass index calculation. Diabetes mellitus in past history and diabetes mellitus first-diagnosed on further patient’s examination were the exclusion criteria. Results. Three reliable risk factors in the construction of multivariate linear regression model were identified: male, body mass index and history of rhythm disorders. With increasing body mass index by 10g/m 2 the levels of glycemia increased by 2.1 mmol/l, glucose level in men was higher than in women by 1.4 mmol/l and the past history of rhythm disorders increased the level of glucose by 3.01 mmol/l. The coefficient of determination (R-squared) was 0.95, which confirmed the high quality of the model. Body mass index was determined to have the greatest impact, using coefficient of elasticity (e = 0.727). The increase of 1% in body mass index led to increase in glucose level by an average of 0.73 %. The relative risk of stress hyperglycemia in patients with a past history of rhythm disorders was 2.94 (95 % CI 1,77–4,88), P ≤ 0.05. Conclusions. In patients with the acute phase of Q-wave myocardial infarction, complicated by acute heart failure, the predictors of stress hyperglycemia development were the body mass index, male and past history of rhythm disorders. In patients with history of rhythm disorders the relative risk of stress hyperglycemia was 2.94 times higher than in persons without history of rhythm disorders.

Mo1267 - The Efficacy of Exercise Intensity and Time on Stress Hyperglycemia in Patients after Pancreaticoduodenectomy

Mo1267 - The Efficacy of Exercise Intensity and Time on Stress Hyperglycemia in Patients after Pancreaticoduodenectomy

Prevalence and prognostic implication of stress hyperglycemia in patients of acute ST elevation myocardial infarction in a tertiary care centre in Eastern India

Prevalence and prognostic implication of stress hyperglycemia in patients of acute ST elevation myocardial infarction in a tertiary care centre in Eastern India