Hiperglucemia inducida por estrés en pacientes ancianos hospitalizados no críticos / Stress-induced hyperglycemia on complications in non-critically elderly hospitalized patients

Objetivos: Tanto las complicaciones hospitalarias como la hiperglucemia son frecuentes en pacientes ancianos durante su hospitalización. Nuestro objetivo fue analizar la relación que existe entre la hiperglucemia y las complicaciones hospitalarias en una población envejecida. Métodos: Llevamos a cabo un estudio observacional para evaluar la relación existente entre las concentraciones de glucosa máxima en sangre (GMS) y las complicaciones hospitalarias. Los pacientes fueron estratificados según los cuartiles de las concentraciones de GMS. La diabetes mellitus (DM) se determinó a través de la historia del paciente y/o los niveles de hemoglobina glucosilada (HbA1c) ≥6,5% en el momento del ingreso hospitalario. La hiperglucemia en pacientes sin DM se definió como hiperglucemia inducida por estrés (HE). El punto final primario compuesto incluyó las complicaciones frecuentes y/o la mortalidad hospitalaria por todas las causas. Resultados: De un total de 461 pacientes, media de edad 80±7,5años, 238 (51,6%) presentaban DM, 20 tenían DM no diagnosticada y 162 (35,1%) desarrollaron complicaciones hospitalarias. Los pacientes con complicaciones presentaban concentraciones diarias medias más altas de glucosa en sangre (215±84 vs. 195±85mg/dl, p<0,01). La incidencia de las complicaciones se asoció directamente a la gravedad de la hiperglucemia, según los cuartiles de las concentraciones de GMS en pacientes sin DM, en concreto HE (<140mg/dl, 22,2%; 140-185mg/dl, 40%; 186-250mg/dl, 47%; >250mg/dl, 60%; p=0,002), no así en pacientes con DM (<140mg/dl, 26,3%; 140-185mg/dl, 40,4%; 186-250mg/dl, 35,6%; >250mg/dl, 37,4%; p=0,748). Según los análisis multivariados que se llevaron a cabo, la HE se asoció, independientemente, a las complicaciones: OR: 2,60 (IC95%: 1,2-5,6), 2,82 (IC95%: 1,2-6,5), 5,50 (IC95%: 1,4-20,8) para el segundo, tercer y cuarto cuartiles, respectivamente (p=0,01) comparado con el primer cuartil. No encontramos relación alguna entre las rehospitalizaciones y la mortalidad por todas las causas. Conclusiones: La HE en pacientes ancianos se asoció a las complicaciones hospitalarias, pero no a la mortalidad por todas las causas, comparado con pacientes con diabetes o con pacientes normoglucémicos

Aims: Hospital complications and hyperglycemia are common in elderly patients during hospitalization. Our aim was to analyze the relationship between hyperglycemia and hospital complications in an ageing population. Methods: We conducted an observational study to evaluate the association between maximum blood glucose (MBG) levels and hospital complications. Patients were stratified according to the quartiles of MBG levels. Diabetes mellitus (DM) was determined by patient history and/or admission glycated hemoglobin (HbA1c) level ≥6.5%. Hyperglycemia in patients without DM was defined as stress-induced hyperglycemia (SH). The composite primary end-point included frequent complications and/or all-cause hospital mortality. Results: Among 461 patients, mean age 80±7.5years, 238 (51.6%) patients had DM, 20 had undiagnosed DM, and 162 (35.1%) developed hospital complications. Patients with complications had higher mean daily BG levels (215±84 vs 195±85mg/dl, P<.01). The incidence of complications was directly associated with severity of hyperglycemia according to the quartiles of MBG levels in patients without DM, namely SH (<140 mg/dl, 22.2%; 140-185mg/dl, 40%; 186-250mg/dl, 47%; >250mg/dl, 60%; P=.002), but not in patients with DM (<140mg/dl, 26.3%; 140-185mg/dl, 40.4%; 186-250mg/dl, 35.6%; >250mg/dl, 37.4%; P=.748). In the multivariate analyses, SH was independently associated with complications: OR 2.60 (CI95%: 1.2-5.6), 2.82 (CI95%: 1.2-6.5), 5.50 (CI95%: 1.4-20.8) for the second, third and fourth quartile respectively (P=.01), as compared to the first quartile. We found no association with readmissions and all-cause mortality. Conclusions: SH in elderly patients is associated with hospital complications, but not with all-cause mortality, compared to patients with diabetes or normoglycemia

Stress-induced hyperglycemia on complications in non-critically elderly hospitalized patients. / Hiperglucemia inducida por estrés en pacientes ancianos hospitalizados no críticos.

AIMS: Hospital complications and hyperglycemia are common in elderly patients during hospitalization. Our aim was to analyze the relationship between hyperglycemia and hospital complications in an ageing population. METHODS: We conducted an observational study to evaluate the association between maximum blood glucose (MBG) levels and hospital complications. Patients were stratified according to the quartiles of MBG levels. Diabetes mellitus (DM) was determined by patient history and/or admission glycated hemoglobin (HbA1c) level ≥6.5%. Hyperglycemia in patients without DM was defined as stress-induced hyperglycemia (SH). The composite primary end-point included frequent complications and/or all-cause hospital mortality. RESULTS: Among 461 patients, mean age 80±7.5years, 238 (51.6%) patients had DM, 20 had undiagnosed DM, and 162 (35.1%) developed hospital complications. Patients with complications had higher mean daily BG levels (215±84 vs 195±85mg/dl, P<.01). The incidence of complications was directly associated with severity of hyperglycemia according to the quartiles of MBG levels in patients without DM, namely SH (<140 mg/dl, 22.2%; 140-185mg/dl, 40%; 186-250mg/dl, 47%; >250mg/dl, 60%; P=.002), but not in patients with DM (<140mg/dl, 26.3%; 140-185mg/dl, 40.4%; 186-250mg/dl, 35.6%; >250mg/dl, 37.4%; P=.748). In the multivariate analyses, SH was independently associated with complications: OR 2.60 (CI95%: 1.2-5.6), 2.82 (CI95%: 1.2-6.5), 5.50 (CI95%: 1.4-20.8) for the second, third and fourth quartile respectively (P=.01), as compared to the first quartile. We found no association with readmissions and all-cause mortality. CONCLUSIONS: SH in elderly patients is associated with hospital complications, but not with all-cause mortality, compared to patients with diabetes or normoglycemia.

[Scurvy, a serious and rare form of avitaminosis, easily diagnosed and treated. Presentation of a case]. / Escorbuto, una grave y rara avitaminosis de fácil diagnóstico y tratamiento. Presentación de un caso.

We report a 66 years-old man case that was admitted with abdominal wall hemorrhagic swelling ecchymosis on inferior extremities and perifollicular purpura with hyperkeratosis of the follicles, which gives it an appearance of palpable purpura, together with gingival hemorrhage and moderate anemia. He was a well-nourished sick man but who made a peculiar diet, practically free from fruit and vegetables which developed a pure and serious form of scurvy. We report this case because we consider that the features which appear are illustrative to provide the immediate clinical diagnosis of this uncommon disease, potentially mortal, but easy to diagnose, if we think about it in the adequate clinical contexts, and which it is quickly curable with the administration of ascorbic acid.