A systematic scoping review on the consequences of stress-related hyperglycaemia

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Abstract

Background

Stress-related hyperglycaemia (SHG) is commonly seen in acutely ill patients and has been associated with poor outcomes in many studies performed in different acute care settings. We aimed to review the available evidence describing the associations between SHG and different outcomes in acutely ill patients admitted to an ICU. Study designs, populations, and outcome measures used in observational studies were analysed.

Methods

We conducted a systematic scoping review of observational studies following the Joanna Briggs methodology. Medline, Embase, and the Cochrane Library were searched for publications between January 2000 and December 2015 that reported on SHG and mortality, infection rate, length of stay, time on ventilation, blood transfusions, renal replacement therapy, or acquired weakness.

Results

The search yielded 3,063 articles, of which 43 articles were included (totalling 536,476 patients). Overall, the identified studies were heterogeneous in study conduct, SHG definition, blood glucose measurements and monitoring, treatment protocol, and outcome reporting. The most frequently reported outcomes were mortality (38 studies), ICU and hospital length of stay (23 and 18 studies, respectively), and duration of mechanical ventilation (13 studies). The majority of these studies (40 studies) compared the reported outcomes in patients who experienced SHG with those who did not. Fourteen studies (35.9%) identified an association between hyperglycaemia and increased mortality (odds ratios ranging from 1.13 to 2.76). Five studies identified hyperglycaemia as an independent risk factor for increased infection rates, and one identified it as an independent predictor of increased ICU length of stay.

Discussion

SHG was consistently associated with poor outcomes. However, the wide divergences in the literature mandate standardisation of measuring and monitoring SHG and the creation of a consensus on SHG definition. A better comparability between practices will improve our knowledge on SHG consequences and management.

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Most cited references 66

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Guidance for conducting systematic scoping reviews.

Micah D.J. Peters, Christina M Godfrey, Hanan Khalil … (2015)

Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the 'scoping review'. In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.

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A literature review on the representativeness of randomized controlled trial samples and implications for the external validity of trial results

Tessa Kennedy-Martin, Sarah E Curtis, Douglas E Faries … (2015)

Randomized controlled trials (RCTs) are conducted under idealized and rigorously controlled conditions that may compromise their external validity. A literature review was conducted of published English language articles that reported the findings of studies assessing external validity by a comparison of the patient sample included in RCTs reporting on pharmaceutical interventions with patients from everyday clinical practice. The review focused on publications in the fields of cardiology, mental health, and oncology. A range of databases were interrogated (MEDLINE; EMBASE; Science Citation Index; Cochrane Methodology Register). Double-abstract review and data extraction were performed as per protocol specifications. Out of 5,456 de-duplicated abstracts, 52 studies met the inclusion criteria (cardiology, n = 20; mental health, n = 17; oncology, n = 15). Studies either performed an analysis of the baseline characteristics (demographic, socioeconomic, and clinical parameters) of RCT-enrolled patients compared with a real-world population, or assessed the proportion of real-world patients who would have been eligible for RCT inclusion following the application of RCT inclusion/exclusion criteria. Many of the included studies concluded that RCT samples are highly selected and have a lower risk profile than real-world populations, with the frequent exclusion of elderly patients and patients with co-morbidities. Calculation of ineligibility rates in individual studies showed that a high proportion of the general disease population was often excluded from trials. The majority of studies (n = 37 [71.2 %]) explicitly concluded that RCT samples were not broadly representative of real-world patients and that this may limit the external validity of the RCT. Authors made a number of recommendations to improve external validity. Findings from this review indicate that there is a need to improve the external validity of RCTs such that physicians treating patients in real-world settings have the appropriate evidence on which to base their clinical decisions. This goal could be achieved by trial design modification to include a more representative patient sample and by supplementing RCT evidence with data generated from observational studies. In general, a thoughtful approach to clinical evidence generation is required in which the trade-offs between internal and external validity are considered in a holistic and balanced manner. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1023-4) contains supplementary material, which is available to authorized users.

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Clinical review: intensive care unit acquired weakness

Greet Hermans, Greet Van den Berghe (2015)

A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as “intensive care unit acquired weakness” (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy. ICUAW is typically symmetrical and affects predominantly proximal limb muscles and respiratory muscles, whereas facial and ocular muscles are often spared. The main risk factors for ICUAW include high severity of illness upon admission, sepsis, multiple organ failure, prolonged immobilization, and hyperglycemia, and also older patients have a higher risk. The role of corticosteroids and neuromuscular blocking agents remains unclear. ICUAW is diagnosed in awake and cooperative patients by bedside manual testing of muscle strength and the severity is scored by the Medical Research Council sum score. In cases of atypical clinical presentation or evolution, additional electrophysiological testing may be required for differential diagnosis. The cornerstones of prevention are aggressive treatment of sepsis, early mobilization, preventing hyperglycemia with insulin, and avoiding the use parenteral nutrition during the first week of critical illness. Weak patients clearly have worse acute outcomes and consume more healthcare resources. Recovery usually occurs within weeks or months, although it may be incomplete with weakness persisting up to 2 years after ICU discharge. Prognosis appears compromised when the cause of ICUAW involves critical illness polyneuropathy, whereas isolated critical illness myopathy may have a better prognosis. In addition, ICUAW has shown to contribute to the risk of 1-year mortality. Future research should focus on new preventive and/or therapeutic strategies for this detrimental complication of critical illness and on clarifying how ICUAW contributes to poor longer-term prognosis.

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Author and article information

Contributors

Elena Olariu: Role: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: Writing – original draftRole: Writing – review & editing

Nicholas Pooley: Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing

Aurélie Danel: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: Writing – review & editing

Montserrat Miret: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: Writing – review & editing

Jean-Charles Preiser: Role: ConceptualizationRole: Formal analysisRole: Writing – review & editing

Chiara Lazzeri: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 6 April 2018

Publication date Collection: 2018

Volume: 13

Issue: 4

Electronic Location Identifier: e0194952

Affiliations

[1 ] PHMR Ltd, London, United Kingdom

[2 ] Nestlé Health Science, Vevey, Switzerland

[3 ] Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

Azienda Ospedaliero Universitaria Careggi, ITALY

Author notes

Competing Interests: PHMR was commissioned by Nestlé Health Science to perform this research. In collaboration with Nestlé Health Science, PHMR wrote the scoping review’s protocol, designed the search strategy and eligibility criteria, performed the study selection, charted the data and summarised the results. A protocol was not registered for this systematic scoping review as PROSPERO currently does not accept systematic scoping review protocols (personal communication). All authors had full access to the data. All authors had final responsibility for the decision to submit for publication. At the time of writing, EO and NP were permanent employees of PHMR; AD and MM are permanent employees of Nestlé Health Science; J-CP has received honoraria for speeches and consultancy fees from Nestlé (Vevey, Switzerland). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

* E-mail: Jean-Charles.Preiser@ 123456erasme.ulb.ac.be

Article

Publisher ID: PONE-D-17-44491

DOI: 10.1371/journal.pone.0194952

PMC ID: 5889160

PubMed ID: 29624594

SO-VID: bafc0013-554e-431d-be36-ab17bd8c7df3

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 22 December 2017

Date accepted : 13 March 2018

Page count

Figures: 2, Tables: 1, Pages: 15

Funding

Funded by: Nestlé Health Science

PHMR was commissioned by Nestlé Health Science to perform this research. In collaboration with Nestlé Health Science, PHMR wrote the scoping review’s protocol, designed the search strategy and eligibility criteria, performed the study selection, charted the data and summarised the results. A protocol was not registered for this systematic scoping review as PROSPERO currently does not accept systematic scoping review protocols (personal communication). All authors had full access to the data. All authors had final responsibility for the decision to submit for publication. At the time of writing, EO and NP were permanent employees of PHMR; AD and MM are permanent employees of Nestlé Health Science; J-CP has received honoraria for speeches and consultancy fees from Nestlé (Vevey, Switzerland).

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Data Availability All data generated or analysed during this study are included in this published article and S1 and S2 Tables.

A systematic scoping review on the consequences of stress-related hyperglycaemia

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Abstract

Background

Methods

Results

Discussion

Related collections

PLOS Climate

Most cited references 66

Guidance for conducting systematic scoping reviews.

A literature review on the representativeness of randomized controlled trial samples and implications for the external validity of trial results

Clinical review: intensive care unit acquired weakness

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Affiliations

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