Acute and Critical Care

Original Article

Pulmonary
Are sodium-glucose co-transporter-2 inhibitors associated with improved outcomes in diabetic patients admitted to intensive care units with septic shock?: Nikita Ashcherkin, Abdelmohaymin A. Abdalla, Simran Gupta, Shubhang Bhatt, Claire I. Yee, Rodrigo Cartin-Ceba; Acute Crit Care. 2024;39(2):251-256. Published online May 14, 2024; DOI: https://doi.org/10.4266/acc.2023.01046

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Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce organ dysfunction in renal and cardiovascular disease. There are limited data on the role of SGLT2i in acute organ dysfunction. We conducted a study to assess the effect of SGLT2i taken prior to intensive care unit (ICU) admission in diabetic patients admitted with septic shock.
Methods
This retrospective cohort study used electronic medical records and included diabetic patients admitted to the ICU with septic shock. We compared diabetic patients on SGLT2i to those who were not on SGLT2i prior to admission. The primary outcome was in-hospital mortality, and secondary outcomes included hospital and ICU length of stay, use of renal replacement therapy, and 28- and 90-day mortality.
Results
A total of 98 diabetic patients was included in the study, 36 in the SGLT2i group and 62 in the non-SGLT2i group. The Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation III scores were similar in the groups. Inpatient mortality was significantly lower in the SGLT2i group (5.6% vs. 27.4%, P=0.008). There was no significant difference in secondary outcomes.
Conclusions
Our study found that diabetic patients on SGLT2i prior to hospitalization who were admitted to the ICU with septic shock had lower inpatient mortality compared to patients not on SGLT2i.

Citations

Citations to this article as recorded by

Sodium-glucose cotransporter-2 inhibitors and sepsis: a story with two tails or with one tail?
Baris Afsar, Rengin Elsurer Afsar, Katherine Tuttle, Krista L. Lentine
Inflammopharmacology.2026;[Epub] CrossRef
Melioidosis in people living with diabetes; clinical presentation, clinical course and implications for patient management
Laura Prideaux, Megan Sandeman, Hayley Stratton, Anthony D Kelleher, Simon Smith, Josh Hanson
Acta Tropica.2025; 263: 107559. CrossRef
High-density lipoprotein: a biomarker and therapeutic target in sepsis
Mohan Li, Marina Barros-Pinkelnig, Sesmu M. Arbous, Christina Christoffersen, Patrick C. N. Rensen, Sander Kooijman
Critical Care.2025;[Epub] CrossRef

Case Report

Severe Hypernatremia with Craniopharyngioma - A Case Report -: Jun Bum Park, Se Hun Park, Eun Hui Seo, Hyun Seok Park, Jin Kyu Jeong; Korean J Crit Care Med. 2013;28(1):46-50.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.46

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Abstract PDF: Hypernatremia, defined as a rise in the serum sodium concentration to a value exceeding 145 mM/L, is a common electrolyte disorder. Diabetes insipidus is a common cause of hypernatremia, caused by impaired production or reduced responses to vasopressin. The resultant morbidity may be inconsequential, serious, or even life-threatening. However, hypernatremia rarely occurs during anesthesia and surgery. A 45-year-old female patient with craniopharyngioma was scheduled for tumor resection. Hypernatremia (serum sodium, 170 mM/L) occurred suddenly at the end of the surgery. To treat hypernatremia, 0.45% normal saline was used. Although serum sodium concentration was reduced faster than expected, the patient did not have any complications.

Original Articles

Clinical Feature and Prognostic Factors of Emphysematous Pyelonephritis: Won Soek Yang, Won Young Kim, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Won Kim, Kyoung Soo Lim; Korean J Crit Care Med. 2012;27(2):89-93.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.89

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Abstract PDF

BACKGROUND
Emphysematous pyelonephritis (EPN) is a rare and potentially life-threatening condition that requires prompt evaluation and management. However, its clinical presentation and outcomes vary widely. This study was conducted to ascertain the clinical features and prognostic factors regarding EPN.
METHODS
All patients diagnosed with EPN radiologically and treated at the emergency department in the university-affiliated, tertiary-referral center, from January 1999 to December 2009 were evaluated. The patients' demographic and clinical characteristics, computed tomographic findings, treatment, and outcomes were analyzed retrospectively.
RESULTS
Overall 14 patients diagnosed with EPN were admitted. There were 12 females and 2 males. A history of diabetes was found in 12 (85.7%) patients and was the most common comorbidity. The chief complaint among patients was flank pain (42.9%). Severe sepsis or septic shock was noted in 10 (71.4%) patients. Thirteen cases had unilateral involvement and one case had bilateral involvement. More than half of patients had Escherichia.coli in culture. Mean serum levels of HbA1c, creatinine, C-reactive protein (CRP) were 9.4 +/- 2.7, 2.4 +/- 1.4 mg/dl, and 22.4 +/- 13.1 mg/dl. Eight (57.1%) patients received antibiotic treatment alone and four (28.6%) patients received the concurrent percutaneous drainage as well as antibiotics. Hospital mortality was 7.1%. A higher initial serum CRP level (20.3 vs. 49.8 mg/dl, p = 0.02) and HbA1c level (8.7 vs. 16.4, p = 0.01) was associated with hospital mortality.
CONCLUSIONS
Antibiotics alone provide a high success rate for the treatment of EPN. Higher serum CRP and HbA1c level was associated with a higher mortality rate in patients with EPN.

Citations

Citations to this article as recorded by

Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock
Soonseong Kwon, Sangchan Jin, Wooik Choi, Sungjin Kim
Korean Journal of Critical Care Medicine.2013; 28(4): 272. CrossRef

Admission Hyperglycemia Aggravates the Prognosis of Critically Ill Patients: Jong Seok Lee, Chul Ho Chang, Yon Hee Shim, Dong Woo Han, Chang Seok Kim, Cheung Soo Shin; Korean J Crit Care Med. 2004;19(2):121-125.

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Abstract PDF: BACKGROUND
Hyperglycemia is a common disease in critically ill patients, even those without diabetes. It has been recognized acute increase of blood glucose level would increase mortality in patients with and without diabetes in vascular disease such as acute myocardial infarct or acute stroke. However, there is not much data about hyperglycemic effects on the prognosis of patients with heterogenous disease in general intensive care unit (ICU). Aim of this study was to evaluate the effects of admission hyperglycemia on prognosis of critically ill patients with heterogenous disease. METHODS: We reviewed medical records of 712 patients admitted general ICU from July, 2000 to March, 2002 in teaching hospital. The patients who were not checked blood glucose level at ICU admission were excluded. We regarded diabetes patients who have been diagnosed diabetes before ICU admission. Hyperglycemia was defined as a fasting glucose level above 140 mg/dl or random glucose level above 200 mg/dl on 2 or more determinations. We measured hospital mortality, ICU stay, and hospital stay as well as blood glucose level. RESULT: Patients mortalities of diabetic hypergylcemia, nondiabetic hyperglycemia, diabetic normoglycemia, and nondiabetic normoglycemia were 17%, 19%, 26% and 10% respectively. CONCLUSIONS: Mortality of diabetic patients regardless of hyperglycemia at admission time and nondiabetic hyperglycemia patients were higher than nondiabetic normoglycemia patients in ICU.

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