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Hypoglycemia Aggravates Critical Illness–Induced Neurocognitive Dysfunction
OBJECTIVE: Tight glycemic control (TGC) in critically ill patients is associated with an increased risk of hypoglycemia. Whether those short episodes of hypoglycemia are associated with adverse morbidity and mortality is a matter of discussion. Using a case-control study design, we investigated whet...
Autores principales: | , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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American Diabetes Association
2010
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827523/ https://www.ncbi.nlm.nih.gov/pubmed/20032274 http://dx.doi.org/10.2337/dc09-1740 |
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author | Duning, Thomas van den Heuvel, Ingeborg Dickmann, Annabelle Volkert, Thomas Wempe, Carola Reinholz, Julia Lohmann, Hubertus Freise, Hendrik Ellger, Björn |
author_facet | Duning, Thomas van den Heuvel, Ingeborg Dickmann, Annabelle Volkert, Thomas Wempe, Carola Reinholz, Julia Lohmann, Hubertus Freise, Hendrik Ellger, Björn |
author_sort | Duning, Thomas |
collection | PubMed |
description | OBJECTIVE: Tight glycemic control (TGC) in critically ill patients is associated with an increased risk of hypoglycemia. Whether those short episodes of hypoglycemia are associated with adverse morbidity and mortality is a matter of discussion. Using a case-control study design, we investigated whether hypoglycemia under TGC causes permanent neurocognitive dysfunction in patients surviving critical illness. RESEARCH DESIGN AND METHODS: From our patient data management system, we identified adult survivors treated for >72 h in our surgical intensive care unit (ICU) between 2004 and 2007 (n = 4,635) without a history of neurocognitive dysfunction or structural brain abnormalities who experienced at least one episode of hypoglycemia during treatment (hypo group) (n = 37). For each hypo group patient, one patient stringently matched for demographic- and disease-related data were identified as a control subject. We performed a battery of neuropsychological tests investigating five areas of cognitive functioning in both groups at least 1 year after ICU discharge. Test results were compared with data from healthy control subjects and between groups. RESULTS: Critical illness caused neurocognitive dysfunction in all tested domains in both groups. The dysfunction was aggravated in hypo group patients in one domain, namely that of visuospatial skills (P < 0.01). Besides hypoglycemia, both hyperglycemia (r = −0.322; P = 0.005) and fluctuations of blood glucose (r = −0.309; P = 0.008) were associated with worse test results in this domain. CONCLUSIONS: Hypoglycemia was found to aggravate critical illness–induced neurocognitive dysfunction to a limited, but significant, extent; however, an impact of hyperglycemia and fluctuations of blood glucose on neurocognitive function cannot be excluded. |
format | Text |
id | pubmed-2827523 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | American Diabetes Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-28275232011-03-01 Hypoglycemia Aggravates Critical Illness–Induced Neurocognitive Dysfunction Duning, Thomas van den Heuvel, Ingeborg Dickmann, Annabelle Volkert, Thomas Wempe, Carola Reinholz, Julia Lohmann, Hubertus Freise, Hendrik Ellger, Björn Diabetes Care Original Research OBJECTIVE: Tight glycemic control (TGC) in critically ill patients is associated with an increased risk of hypoglycemia. Whether those short episodes of hypoglycemia are associated with adverse morbidity and mortality is a matter of discussion. Using a case-control study design, we investigated whether hypoglycemia under TGC causes permanent neurocognitive dysfunction in patients surviving critical illness. RESEARCH DESIGN AND METHODS: From our patient data management system, we identified adult survivors treated for >72 h in our surgical intensive care unit (ICU) between 2004 and 2007 (n = 4,635) without a history of neurocognitive dysfunction or structural brain abnormalities who experienced at least one episode of hypoglycemia during treatment (hypo group) (n = 37). For each hypo group patient, one patient stringently matched for demographic- and disease-related data were identified as a control subject. We performed a battery of neuropsychological tests investigating five areas of cognitive functioning in both groups at least 1 year after ICU discharge. Test results were compared with data from healthy control subjects and between groups. RESULTS: Critical illness caused neurocognitive dysfunction in all tested domains in both groups. The dysfunction was aggravated in hypo group patients in one domain, namely that of visuospatial skills (P < 0.01). Besides hypoglycemia, both hyperglycemia (r = −0.322; P = 0.005) and fluctuations of blood glucose (r = −0.309; P = 0.008) were associated with worse test results in this domain. CONCLUSIONS: Hypoglycemia was found to aggravate critical illness–induced neurocognitive dysfunction to a limited, but significant, extent; however, an impact of hyperglycemia and fluctuations of blood glucose on neurocognitive function cannot be excluded. American Diabetes Association 2010-03 2009-12-23 /pmc/articles/PMC2827523/ /pubmed/20032274 http://dx.doi.org/10.2337/dc09-1740 Text en © 2010 by the American Diabetes Association. https://creativecommons.org/licenses/by-nc-nd/3.0/Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ (https://creativecommons.org/licenses/by-nc-nd/3.0/) for details. |
spellingShingle | Original Research Duning, Thomas van den Heuvel, Ingeborg Dickmann, Annabelle Volkert, Thomas Wempe, Carola Reinholz, Julia Lohmann, Hubertus Freise, Hendrik Ellger, Björn Hypoglycemia Aggravates Critical Illness–Induced Neurocognitive Dysfunction |
title | Hypoglycemia Aggravates Critical Illness–Induced Neurocognitive Dysfunction |
title_full | Hypoglycemia Aggravates Critical Illness–Induced Neurocognitive Dysfunction |
title_fullStr | Hypoglycemia Aggravates Critical Illness–Induced Neurocognitive Dysfunction |
title_full_unstemmed | Hypoglycemia Aggravates Critical Illness–Induced Neurocognitive Dysfunction |
title_short | Hypoglycemia Aggravates Critical Illness–Induced Neurocognitive Dysfunction |
title_sort | hypoglycemia aggravates critical illness–induced neurocognitive dysfunction |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827523/ https://www.ncbi.nlm.nih.gov/pubmed/20032274 http://dx.doi.org/10.2337/dc09-1740 |
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