Christian Gantzel Nielsen, Mikkel Thor Olsen, Peter Lommer Kristensen, Martin Schønemann-Lund, Pär Ingemar Johansson, Ulrik Pedersen-Bjergaard, Morten Heiberg Bestle
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The aim of this study was to investigate the associations between dysglycemia and endotheliopathy to inform future glycemic management.</p><p><strong>Design, setting, and participants: </strong>This prospective observational study included 577 acutely admitted adult ICU patients at Copenhagen University Hospital-North Zealand, Denmark.</p><p><strong>Main outcomes and measures: </strong>Up to twenty-four hours of patient glycemia was paired with same-day levels of endothelial biomarkers measured after each 24-hour period for three consecutive days. Endotheliopathy was assessed by measurement of Syndecan-1, Platelet Endothelial Cell Adhesion Molecule-1 (PECAM-1), and soluble thrombomodulin (sTM).</p><p><strong>Results: </strong>Of the included patients, a total 57.5% were males, median age was 71 yr (interquartile range [IQR], 63-79), and 24.6% had diabetes prior to admission. Median admission time was 5 d (IQR, 3-10). Time above range (TAR) greater than 13.9 mmol/L, but not TAR 10.0-13.9 mmol/L, was associated with increase in sTM (0.01 ng/mL per %-point increase in TAR, p = 0.049) and PECAM-1 (0.01 ng/mL per %-point increase, p = 0.007). Glycemic variability was associated with increases in sTM (0.24 ng/mL per mmol/L increase in sd, p = 0.001 and 0.03 ng/mL per %-point increase in coefficient of variation, p < 0.001). Hypoglycemia 3.0-3.9 mmol/L was associated with increases in sTM (3.0 ng/mL, p < 0.001) and PECAM-1 (1.54 ng/mL, p < 0.001).</p><p><strong>Conclusions and relevance: </strong>In acutely admitted adult ICU patients, hypoglycemia was associated with endotheliopathy regardless of preadmission diabetes status. Hyperglycemia and high glycemic variability were associated with endotheliopathy in patients without diabetes. This suggests different responses to acute dysglycemia in patients with and without diabetes and warrants further investigation in clinical trials.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"7 4","pages":"e1229"},"PeriodicalIF":2.7000,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936623/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Association Between Dysglycemia and Endotheliopathy in ICU Patients With and Without Diabetes: A Cohort Study.\",\"authors\":\"Christian Gantzel Nielsen, Mikkel Thor Olsen, Peter Lommer Kristensen, Martin Schønemann-Lund, Pär Ingemar Johansson, Ulrik Pedersen-Bjergaard, Morten Heiberg Bestle\",\"doi\":\"10.1097/CCE.0000000000001229\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Dysglycemia in critically ill patients is associated with endotheliopathy. This relationship may be altered in patients with diabetes.</p><p><strong>Objectives: </strong>Dysglycemia is common in critically ill patients and associated with increased mortality. Endotheliopathy is thought to play a role in this relationship; however, evidence is scarce. The aim of this study was to investigate the associations between dysglycemia and endotheliopathy to inform future glycemic management.</p><p><strong>Design, setting, and participants: </strong>This prospective observational study included 577 acutely admitted adult ICU patients at Copenhagen University Hospital-North Zealand, Denmark.</p><p><strong>Main outcomes and measures: </strong>Up to twenty-four hours of patient glycemia was paired with same-day levels of endothelial biomarkers measured after each 24-hour period for three consecutive days. Endotheliopathy was assessed by measurement of Syndecan-1, Platelet Endothelial Cell Adhesion Molecule-1 (PECAM-1), and soluble thrombomodulin (sTM).</p><p><strong>Results: </strong>Of the included patients, a total 57.5% were males, median age was 71 yr (interquartile range [IQR], 63-79), and 24.6% had diabetes prior to admission. Median admission time was 5 d (IQR, 3-10). Time above range (TAR) greater than 13.9 mmol/L, but not TAR 10.0-13.9 mmol/L, was associated with increase in sTM (0.01 ng/mL per %-point increase in TAR, p = 0.049) and PECAM-1 (0.01 ng/mL per %-point increase, p = 0.007). Glycemic variability was associated with increases in sTM (0.24 ng/mL per mmol/L increase in sd, p = 0.001 and 0.03 ng/mL per %-point increase in coefficient of variation, p < 0.001). 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引用次数: 0
摘要
重要性：危重患者血糖异常与内皮病变相关。这种关系在糖尿病患者中可能会改变。目的：血糖异常在危重患者中很常见，并与死亡率增加有关。内皮病变被认为在这种关系中起作用；然而，证据很少。本研究的目的是调查血糖异常和内皮病变之间的关系，为未来的血糖管理提供信息。设计、环境和参与者：这项前瞻性观察性研究包括577名丹麦哥本哈根大学医院重症监护病房急性入院的成人患者。主要结果和测量方法：连续3天，每24小时测量一次患者24小时的血糖，同时测量内皮生物标志物的当日水平。通过测量Syndecan-1、血小板内皮细胞粘附分子-1 （PECAM-1）和可溶性血栓调节素（sTM）来评估内皮病变。结果：纳入的患者中，男性占57.5%，中位年龄71岁（四分位间距[IQR]， 63-79），入院前患有糖尿病的患者占24.6%。入院时间中位数为5 d （IQR, 3-10）。高于13.9 mmol/L的时间（TAR）与sTM （TAR每增加%-point 0.01 ng/mL, p = 0.049）和PECAM-1（每增加%-point 0.01 ng/mL, p = 0.007）升高相关。血糖变异性与sTM的增加相关（sd每mmol/L增加0.24 ng/mL, p = 0.001，变异系数每增加% 1点增加0.03 ng/mL, p < 0.001）。低血糖3.0 ~ 3.9 mmol/L与sTM （3.0 ng/mL, p < 0.001）和PECAM-1 （1.54 ng/mL, p < 0.001）升高相关。结论和相关性：在急性入院的成人ICU患者中，无论入院前是否患有糖尿病，低血糖都与内皮病变相关。在非糖尿病患者中，高血糖和高血糖变异性与内皮病变相关。这表明糖尿病患者和非糖尿病患者对急性血糖异常的反应不同，值得在临床试验中进一步研究。
The Association Between Dysglycemia and Endotheliopathy in ICU Patients With and Without Diabetes: A Cohort Study.
Importance: Dysglycemia in critically ill patients is associated with endotheliopathy. This relationship may be altered in patients with diabetes.
Objectives: Dysglycemia is common in critically ill patients and associated with increased mortality. Endotheliopathy is thought to play a role in this relationship; however, evidence is scarce. The aim of this study was to investigate the associations between dysglycemia and endotheliopathy to inform future glycemic management.
Design, setting, and participants: This prospective observational study included 577 acutely admitted adult ICU patients at Copenhagen University Hospital-North Zealand, Denmark.
Main outcomes and measures: Up to twenty-four hours of patient glycemia was paired with same-day levels of endothelial biomarkers measured after each 24-hour period for three consecutive days. Endotheliopathy was assessed by measurement of Syndecan-1, Platelet Endothelial Cell Adhesion Molecule-1 (PECAM-1), and soluble thrombomodulin (sTM).
Results: Of the included patients, a total 57.5% were males, median age was 71 yr (interquartile range [IQR], 63-79), and 24.6% had diabetes prior to admission. Median admission time was 5 d (IQR, 3-10). Time above range (TAR) greater than 13.9 mmol/L, but not TAR 10.0-13.9 mmol/L, was associated with increase in sTM (0.01 ng/mL per %-point increase in TAR, p = 0.049) and PECAM-1 (0.01 ng/mL per %-point increase, p = 0.007). Glycemic variability was associated with increases in sTM (0.24 ng/mL per mmol/L increase in sd, p = 0.001 and 0.03 ng/mL per %-point increase in coefficient of variation, p < 0.001). Hypoglycemia 3.0-3.9 mmol/L was associated with increases in sTM (3.0 ng/mL, p < 0.001) and PECAM-1 (1.54 ng/mL, p < 0.001).
Conclusions and relevance: In acutely admitted adult ICU patients, hypoglycemia was associated with endotheliopathy regardless of preadmission diabetes status. Hyperglycemia and high glycemic variability were associated with endotheliopathy in patients without diabetes. This suggests different responses to acute dysglycemia in patients with and without diabetes and warrants further investigation in clinical trials.
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