Cargando…

Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission

BACKGROUNDS: Stress hyperglycemia ratio (SHR) reflects the acute blood glucose change in response to acute illnesses or injuries, including pneumonia. We aimed to investigate the associations of SHR with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission....

Descripción completa

Detalles Bibliográficos
Autores principales: Liu, Bing, Chen, Yu, Yu, Liping, Zhou, Min
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Publishing Asia Pty Ltd 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10345973/
https://www.ncbi.nlm.nih.gov/pubmed/37144245
http://dx.doi.org/10.1111/1753-0407.13398
_version_ 1785073210932330496
author Liu, Bing
Chen, Yu
Yu, Liping
Zhou, Min
author_facet Liu, Bing
Chen, Yu
Yu, Liping
Zhou, Min
author_sort Liu, Bing
collection PubMed
description BACKGROUNDS: Stress hyperglycemia ratio (SHR) reflects the acute blood glucose change in response to acute illnesses or injuries, including pneumonia. We aimed to investigate the associations of SHR with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission. METHODS: A multicenter and retrospective study was conducted among diabetic inpatients with pneumonia on admission via electronic medical records from 2013 to 2019 in Ruijin Hospital, Shengjing Hospital, and China‐Japan Friendship Hospital. RESULTS: The study included 1631 diabetic inpatients with pneumonia on admission. Patients of the fourth quartile (Q4) of SHR on admission showed significantly elevated systemic inflammation compared with those of the first quartile (Q1), second quartile (Q2), or third quartile (Q3) of SHR, including more white blood cells (9.1 × 10(9)/L in Q4 vs 7.6 × 10(9)/L in Q1, 7.9 × 10(9)/L in Q2, and 8.0 × 10(9)/L in Q3, p < .001), higher neutrophil‐to‐lymphocyte ratio (7.0 in Q4 vs 3.6 in Q1, 3.8 in Q2, and 4.0 in Q3, p < .001), higher C‐reactive protein (52.8 mg/L in Q4 vs 18.9 mg/L in Q1, p < .001; 52.8 mg/L in Q4 vs 28.6 mg/L in Q2, p = .002), higher procalcitonin (0.22 ng/mL in Q4 vs 0.10 ng/mL in Q1, 0.09 ng/mL in Q2, and 0.11 ng/mL in Q3, p < .001), and higher D‐dimer (0.67 mg/L in Q4 vs 0.47 mg/L in Q1, 0.50 mg/L in Q2, and 0.47 mg/L in Q3, p < .001). Excluding patients with hypoglycemia on admission in the analyses, there were still distinct J‐shaped associations between SHR and adverse clinical outcomes in patients with different severity of pneumonia, especially in those with CURB‐65 score for pneumonia severity (Confusion, blood Urea nitrogen, Respiratory rate, Blood pressure) ≥ 2. In the multivariable regression model, predictive value for adverse clinical outcomes was higher when SHR was taken as a spline term than as quartiles in all patients (area under curve 0.831 vs 0.822, p = .040), and when SHR as a spline term instead of fasting blood glucose was included in patients with CURB‐65 ≥ 2 (area under curve 0.755 vs 0.722, p = .027). CONCLUSIONS: SHR was correlated with systematic inflammation and of J‐shaped associations with adverse clinical outcomes in diabetic inpatients with pneumonia of different severity. The inclusion of SHR in the blood glucose management of diabetic inpatients may be beneficial, especially for the prevention of potential hypoglycemia or the recognition of relative glucose insufficiency in those with severe pneumonia or high hemoglobin A(1C).
format Online
Article
Text
id pubmed-10345973
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Wiley Publishing Asia Pty Ltd
record_format MEDLINE/PubMed
spelling pubmed-103459732023-07-15 Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission Liu, Bing Chen, Yu Yu, Liping Zhou, Min J Diabetes Editor's Recommendations BACKGROUNDS: Stress hyperglycemia ratio (SHR) reflects the acute blood glucose change in response to acute illnesses or injuries, including pneumonia. We aimed to investigate the associations of SHR with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission. METHODS: A multicenter and retrospective study was conducted among diabetic inpatients with pneumonia on admission via electronic medical records from 2013 to 2019 in Ruijin Hospital, Shengjing Hospital, and China‐Japan Friendship Hospital. RESULTS: The study included 1631 diabetic inpatients with pneumonia on admission. Patients of the fourth quartile (Q4) of SHR on admission showed significantly elevated systemic inflammation compared with those of the first quartile (Q1), second quartile (Q2), or third quartile (Q3) of SHR, including more white blood cells (9.1 × 10(9)/L in Q4 vs 7.6 × 10(9)/L in Q1, 7.9 × 10(9)/L in Q2, and 8.0 × 10(9)/L in Q3, p < .001), higher neutrophil‐to‐lymphocyte ratio (7.0 in Q4 vs 3.6 in Q1, 3.8 in Q2, and 4.0 in Q3, p < .001), higher C‐reactive protein (52.8 mg/L in Q4 vs 18.9 mg/L in Q1, p < .001; 52.8 mg/L in Q4 vs 28.6 mg/L in Q2, p = .002), higher procalcitonin (0.22 ng/mL in Q4 vs 0.10 ng/mL in Q1, 0.09 ng/mL in Q2, and 0.11 ng/mL in Q3, p < .001), and higher D‐dimer (0.67 mg/L in Q4 vs 0.47 mg/L in Q1, 0.50 mg/L in Q2, and 0.47 mg/L in Q3, p < .001). Excluding patients with hypoglycemia on admission in the analyses, there were still distinct J‐shaped associations between SHR and adverse clinical outcomes in patients with different severity of pneumonia, especially in those with CURB‐65 score for pneumonia severity (Confusion, blood Urea nitrogen, Respiratory rate, Blood pressure) ≥ 2. In the multivariable regression model, predictive value for adverse clinical outcomes was higher when SHR was taken as a spline term than as quartiles in all patients (area under curve 0.831 vs 0.822, p = .040), and when SHR as a spline term instead of fasting blood glucose was included in patients with CURB‐65 ≥ 2 (area under curve 0.755 vs 0.722, p = .027). CONCLUSIONS: SHR was correlated with systematic inflammation and of J‐shaped associations with adverse clinical outcomes in diabetic inpatients with pneumonia of different severity. The inclusion of SHR in the blood glucose management of diabetic inpatients may be beneficial, especially for the prevention of potential hypoglycemia or the recognition of relative glucose insufficiency in those with severe pneumonia or high hemoglobin A(1C). Wiley Publishing Asia Pty Ltd 2023-05-05 /pmc/articles/PMC10345973/ /pubmed/37144245 http://dx.doi.org/10.1111/1753-0407.13398 Text en © 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Editor's Recommendations
Liu, Bing
Chen, Yu
Yu, Liping
Zhou, Min
Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission
title Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission
title_full Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission
title_fullStr Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission
title_full_unstemmed Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission
title_short Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission
title_sort stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission
topic Editor's Recommendations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10345973/
https://www.ncbi.nlm.nih.gov/pubmed/37144245
http://dx.doi.org/10.1111/1753-0407.13398
work_keys_str_mv AT liubing stresshyperglycemiaratioisassociatedwithsystemicinflammationandclinicaloutcomesindiabeticinpatientswithpneumoniaonadmission
AT chenyu stresshyperglycemiaratioisassociatedwithsystemicinflammationandclinicaloutcomesindiabeticinpatientswithpneumoniaonadmission
AT yuliping stresshyperglycemiaratioisassociatedwithsystemicinflammationandclinicaloutcomesindiabeticinpatientswithpneumoniaonadmission
AT zhoumin stresshyperglycemiaratioisassociatedwithsystemicinflammationandclinicaloutcomesindiabeticinpatientswithpneumoniaonadmission