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Association of glycosylated hemoglobin with mortality of patients in intensive care unit: a prospective observation study

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Kumar D. S., Wasnik S. B., Yadav A., Yadav R.
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issue 1
24-33
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INTRODUCTION: Glycated hemoglobin (HbA1c) is the most commonly used clinical test to estimate mean blood glucose during the past 2 to 3 months. In addition to diagnostic purposes, the HbA1c level also predicts diabetes complications. The aim of this study was to determine the association of glycosylated hemoglobin with mortality in intensive care unit (ICU). MATERIALS AND METHODS: A prospective observational study was conducted in the ICU with a total of 281 patients. These patients were classified into two groups based on their HbA1c levels: one group with HbA1c level < 6.5 % and another group with HbA1c level ≥ 6.5%. The following data were collected during the study period. Clinical details and scores such as the APACHE II score (Acute Physiology and Chronic Health Assessment) and daily SOFA (Sequential Organ Failure Assessment) scores for the period of stay in the ICU. ICU morbidities as the need for mechanical ventilation, the use of inotropes / vasopressors, the length of stay in the ICU, and the requirement of renal replacement therapy (RRT). The outcome measures were ICU mortality and 28-day mortality. RESULTS: Of 281 patients admitted to the ICU for more than 48 hours, 157 patients (55.9%) had HbA1c levels < 6.5%, with the remaining 124 (44.1%) had levels ≥ 6.5%. ICU mortality was present in 107 (38.07%) cases. ICU mortality was higher in patients in the HbA1c ≥ 6.5% group compared to the HbA1c < 6.5% group. This was statistically significant (p-value <0.001). Mortality at 28 days was observed in 125 (44.48%) cases. Patients with an HbA1c value ≥ 6.5%, there was a higher mortality at 28 days compared to patients with an HbA1c value < 6.5%. This was found to be statistically significant (p-value <0.001). CONCLUSIONS: The study showed that glycated hemoglobin levels (HbA1c) levels ≥ 6.5% had a significantly higher mortality rate compared to the patient in the HbA1c level < 6.5%.
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Anaesthetic management of a pregnant women taking sildenafil for intra uterine growth retardation undergoing caesarean section: a case report

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Kumar S., Nayak S. S., Yadav U., Yadav R.
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The role of Sildenafil was found in the potential weight gain of the foetus in pregnant women with intrauterine growth retardation (IUGR). Sildenafil acted by inhibiting phosphodiesterase type 5 (PDE5), which was an important enzyme responsible for the degradation of Cyclic guanosine monophosphate (cGMP), resulting in prolongation of action of cGMP and therefore prolonged smooth muscle relaxation and vasodilation of smooth muscle. The mechanism behind the beneficial effect on IUGR was its vasodilator action and, hence, an increase in uteroplacental circulation. But the main issue during anaesthesia was fear of severe hypotension, ocular side effects, and bleeding due to the effect of sildenafil. which was expected in pregnant women taking Sildenafil for intrauterine growth retardation undergoing caesarean section. Severe hypotension was due to augmentation of hypotensive effect of sildenafil and regional anaesthesia. A 29-year-old female, previously healthy, non-smoking, at 33 weeks’ period of gestation presented with complaints of headache and pedal edema in third trimester and was diagnosed with gestational hypertension. On the 28th day of admission, she had episodes of elevated blood pressure. The patient was considered for emergency caesarean section after taking high-risk consent. Techniques for cesarean sections include the single shot spinal technique, epidural catheter technique, or the combined spinal-epidural technique (CSE). While spinal anaesthesia offers a simpler approach with a faster and more reliable onset of surgical anaesthesia, it may be associated with abrupt hemodynamic changes. On the contrary, epidural anaesthesia allows for a gradual onset of sympathectomy, titrated dosing, and postoperative analgesia. In this case, the decision was made to opt for epidural anaesthesia over spinal approach was made to allow for careful drug titration and enhance hemodynamic stability. We conclude that graded epidural epidural anaesthesia played an important role in the prevention of hypotension that was expected in pregnant women taking Sildenafil for intrauterine growth retardation undergoing caesarean section.
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Correlation of vitamin D deficiency with mortality in critically ill patients admitted to the intensive care unit

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Joshi V. M., Wasnik S. B., Yadav A., Yadav R.
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EN
INTRODUCTION: Vitamin D, which is a fat-soluble vitamin, plays a key role in enhancing the intestinal absorption of calcium, magnesium and phosphate. In severely ill patients, vitamin D can adversely affect immune and metabolic functions, contributing to poorer outcomes. The aim of this study was to correlate vitamin D with mortality in critically ill patients. MATERIALS AND METHODS: prospective observational study was conducted, involving 162 patients in an intensive care unit (ICU). 162 patients were divided into two groups according to vitamin D Deficiency Group levels ≤ 20 ng/ml and Non vitamin D deficiency group levels <20 ng / ml and non-vitamin D deficiency group B levels > 20ng/ml. Data collected during the study included the APACHE II (acute physiology and chronic health evaluation) score at ICU admission, SOFA (sequential organ failure assessment) scores throughout the ICU stay, the need for mechanical ventilation, inotropic support, length of stay in ICU, and ICU outcomes, which were classified as either discharge or mortality. RESULTS: Of the 162 patient admitted to ICU, the prevalence of vitamin D deficiency in this study was 140 (86.4%) and nondeficient 22 (13.6%). The mortality rate in the vitamin D deficient group was 40% compared to 18.18% in the nondeficient group. The difference in mortality in both groups for mortality was statistically significant (p-value < 0.05). Vitamin D deficiency was not associated as an independent risk factor for ICU mortality [Odds ratio (OR) 1.220, 95% CI (0.825- 1.805) (p-value -0.320)]. CONCLUSIONS: The vitamin D-deficient group had a significantly higher mortality rate compared to the patient in the nondeficient group. But vitamin D deficiency was not found to be an independent risk factor for mortality.
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Lactate / albumin ratio as prognostic tool for risk stratification in septic patients admitted to ICU

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Mourya V., Gupta R., Yadav A., Yadav R.
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EN
INTRODUCTION: Sepsis stands as the primary cause behind intensive care unit (ICU) admissions. The most critical parameters in sepsis management have been shown to be early recognition. Management delays have been associated with increased mortality and morbidity The aim of this study is to study the lactate/albumin (L/A) ratio as prognostic tool for risk stratification in septic patients admitted to ICU. MATERIALS AND METHODS: This prospective observational study was conducted with100 patients. Admitted in ICU with sepsis and septic shock were studied. Serum lactate/albumin ratio was calculated at the time of admission. Apache 2 and SOFA score was calculated at admission. All patients received initial treatment according standard protocol. All patients were followed up till discharge. An adverse outcome in terms of in hospital mortality, length of ICU stays and inotropic support was used in this study. RESULTS: Lactate/albumin ratio >1.5(AUC 0.89) correctly predicted in-hospital mortality among 27% patients with sensitivity and specificity of 90% and 78.6% respectively (p value =0.001). Lactate/albumin ratio <1.50 (AUC 0.73) correctly predicted length of ICU stays <72 hours among 17% patients with sensitivity and specificity of 85% and 58.8% respectively (p value =0.001). Lactate/albumin ratio >1.50 (AUC 0.91) correctly predicted requiring inotropic support among 36% patients with sensitivity and specificity of 83.7% and 89.5% respectively (p value =0.001). CONCLUSIONS: We concluded that lactate/albumin ratio was a stronger parameter than lactate, albumin, APACHE score and SOFA alone in predicting mortality, length of ICU stay and requiring noradrenaline inotropic support among sepsis patients in the ICU.
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