Prognostic Significance Of Mean Amplitude Of Glycemic Excursions And The Level Of Inflammatory Factor In Critically Ill Patients

Background and ObjectiveIt can be generally seen that critically ill patients in ICU pretend to have high blood glucose, which will increase damage to important organs such as heart, brain and kidney, et al and worsen condition. High blood inflammatory factors disease might be one of the causes to high blood glucose during stress. It can synergize with blood glucose, influencing patients' prognosis.The dysglycemia of diabetes includes two components:(1) sustained chronic hyperglycemia that exerts its effects through both excessive protein glycation and activation of oxidative stress and (2) acute glucose fluctuations.Glycemic variability, an Hb Alc-independent risk factor, has more deleterious effects than sustained hyperglycemia in the development of diabetic complications.To investigate the relationship among Mean Amplitude of Glycemic Excursions (MAGE), inflammatory factors (CRP, TNF-α, IL-6) and prognosis in critically ill patients in ICU.MethodsThe study included 60 subjects (36 male subjects and 22 female subjects, mean age=55.3±8.9,2 subjects withdrew) with APACHEⅡ(acute physiology and chronic health evaluationⅡ) scores over 10, stress hyperglycemia, non-diabetic history and HbA (1c) between 4% and 6% who were admitted to ICU between January 2010 and January 2011. Monitor MAGE by CGMS (continuous glucose monitoring system) for 12 hours after admission, measure serum levels of CRP, TNF-αand IL-6, and observe prognosis 28days later. Analyze the relationship among MAGE, inflammatory factors and APACHEⅡscores. Group:The patients were divided according to the worst serum index APACHEⅡscore when they admited into hospital within 24 hours:group A:11 to 19 scores (27 patients); group B:20 to 25 scores (21 patients); group C:greater than 25 scores(10 patients).20 healthy people from outpatient department were selected as NC group,which included 11 males,9 females and their average age was (53.8±4.6) years.The relationship with MAGE and APACHEⅡscore were investigated.Therapy:All research subjects applied 0.9% sodium chloride injection instead of glucose injection. If can not substitute for special patients,glucose injuction joined insulin proportionally could be used(4 to 6 gram glucose with 1U insulin) for therapy.Meanwhile, nutrition supportive treatment was offered by vein or enteral nutrition to provide adequate calories and protein to maintain the body's celluar energy needs.Patients with severe stress were treated with low heat nutrition supportive to avoid further glucose increasement.When plasma glucose kept on exceeding 10mmol/L, the start of insulin therapy to lower the plasma glucose.Besides, special patients who had to use medicine which may effect plasma glucose fluctuation greatly were unselected.1.APACHEⅡscore:Application for APACHEⅡscore software to calculate APACHEⅡtotal score when patients admited into ICU within 24 hours according to the worst serum index among the 12 ones.2.Continuous glucose monitoring::After 72 hours of application for continuous glucose monitoring system(CGMS), continuous glucose monitoring atlas for data analysis were downloaded with special sofeware.The MAGE was calculated mainly based on the first complete 24-hour dynamic glucose monitoring atlas.3. Measurement of serume TNF-a and IL-6:Application for ELISA to measure serume TNF-αand IL-6.The kit was purchased from RB company, America.4. Measurement of serum CRP:Application for nephelometry to accomplish serum CRP detection.5. Statistical Analysis:All data were described as (?)±s.Application for statistical software SPSS 13.0 to analyze the data. The data had significant differences when P value was less than 0.05. Correlation analysis used Pearson correlation. T test and X2 test were used for comparison within groups.Multiple linear regression and multiple Logistic regression analysis were used for multiplicity.Results(1) MAGE, CRP, TNF-aand IL-6 were significantly elevated in 58 cases, and had statistical significance compared to controls (P<0.01). Moreover, MAGE is positively correlated with blood levels of CRP, TNF-aand IL-6. APACHEⅡscored greater, then MAGE, CRP, TNF-aand IL-6 were higher.(2) Pearson Correlation Analysis showed that 24 hours after admission MAGE correlated closely with CRP, TNF-α, IL-6 and APACHEⅡ(r=0.622,0.505,0.509,0.597; P<0.01);(3) Multivariate linear regression analysis suggested MAGE and IL-6 played more important roles in APACHEⅡscores (P<0.05);(4)Compared with survivors, subjects who died at the end of our study had much higher levels of MAGE and APACHEⅡ(P<0.01). Logistic Regression indicated MAGE can influence patients' motality, OR=4.401 (95% CI:2.185～6.618, P<0.05)Conclusion(1) Critically ill patients within 24 h MAGE, and serum inflammatory factor CRP, TNF-αand IL-6 levels were significantly increased than normal. Moreover, MAGE is positively correlated with blood levels of CRP, TNF-αand IL-6. APACHEⅡscored greater, then MAGE, CRP, TNF-αand IL-6 were higher.(2) Pearson Correlation Analysis showed that 24 hours after admission MAGE is closely associated with critically ill patients' condition.(3) Multivariate linear regression analysis suggested MAGE and IL-6 played more important roles in APACHEⅡ.(4)Compared with survivors, subjects who died at the end of our study had much higher levels of MAGE(5) MAGE can be an independent predictor in the prognosis of patients in ICU.And Lower glucose variability in critically ill patients in the ICU degree of may have a protective effect.