Impact of Hyperglycemia in the Outcome of Patients with Primary Neuromuscular Respiratory Failure
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ORIGINAL ARTICLE
Impact of Hyperglycemia in the Outcome of Patients with Primary Neuromuscular Respiratory Failure Macarena Cabrera-Serrano • Jennifer E. Fugate Jay Mandrekar • Alejandro A. Rabinstein
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Ó Springer Science+Business Media New York 2015
Abstract Background Hyperglycemia has been found to be associated with higher risk of ICU-acquired weakness. However, the impact of hyperglycemia on the outcome of patients with respiratory failure from a primary neuromuscular condition is not known. Methods We reviewed 85 patients admitted to an ICU at Mayo Clinic (Rochester) with primary acute neuromuscular respiratory failure. Time of hyperglycemia (defined as >140 mg/dL and as >180 mg/dL) was calculated for each patient. Associations between hyperglycemic time, insulin administered, and outcome measures (duration of mechanical ventilation, in-hospital mortality, functional outcome at discharge, and at last follow-up) were evaluated using logistic regression analysis. Results Although longer hyperglycemic time was associated with longer mechanical ventilation time and poorer short-term outcome on univariate analyses, these associations were no longer present when the analysis was adjusted for length of ICU stay. On this adjusted analysis, there were no significant associations between hyperglycemic time and duration of mechanical ventilation, inhospital mortality, or functional outcome at discharge or at follow-up either for the entire cohort or for relevant
M. Cabrera-Serrano J. E. Fugate A. A. Rabinstein (&) Department of Neurology, Mayo Clinic, 200 First Street SW – Mayo W8B, Rochester, MN 55905, USA e-mail: [email protected] M. Cabrera-Serrano Instituto de Biomedicina de Sevilla, Hospital Virgen del Rocı´o, Seville, Spain J. Mandrekar Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
subgroups (diabetics, non-diabetics, patients with neuropathy). The amount of insulin administered did not influence the outcome measures. Neither hyperglycemia nor the amount of insulin during the first 7 days of ICU admission was associated with any of the outcome measures. Conclusions In our cohort, we did not find evidence that the duration of hyperglycemia or the amount of insulin given had any major impact on the outcomes of patients with primary acute neuromuscular respiratory failure. Keywords Hyperglycemia Insulin Neuropathy Neuromuscular Neurotoxicity
Introduction Acute respiratory failure from a primary neuromuscular condition can occur with the presence of an acute condition, such as Guillain–Barre syndrome (GBS), or as a deterioration of a chronic one, such as myasthenia gravis (MG) in patients. Frequently the primary diagnosis is initially unknown [1]. Consequently, during the first few days the management is based on a syndromic diagnosis. Prognostic factors and interventions applicable to these cases as a group are, therefore, useful. We have previously shown that pulmonary function tests and blood gases can be used to predict the outcome of these patients [2]. Hyperglycemia
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