PDF(Pubmed)
Abstract：
Glycaemic dysregulation potentiates the pro-inflammatory response and increases oxidative injury; therefore, preoperative hyperglycaemia is linked to increased mortalities. In addition, inflammation is accompanied by higher glycated haemoglobin (HbA1c) levels, and the relationship between this and random blood sugar (RBS) could be non-linear.
This is a cross-sectional study. Non-diabetic paediatric patients with acute surgical abdomen, presenting to the emergency surgical services were enrolled, over a period of 6 months. They were all screened for their random blood sugar and HbA1c levels.
Fifty-three cases were studied. The prevalence of glycaemic dysregulation in the enrolled children was high. Abnormal HbA1c was observed in 66% of the study group. Stress hyperglycaemia was observed in 60% of the enrolled children. There was a significant correlation (r = 0.770, p-value: < 0.001) between RBS and the total leucocytic count (TLC). The TLC cutoff value for predicting stress hyperglycaemia was 13,595 cells/mm3. The cutoff value of RBS for predicting leukocytosis was 111.5 mg/dl. Median RBS level was significantly higher in complicated appendicitis (169.5 mg/dl), compared to uncomplicated appendicitis (118.0 mg/dl).
HbA1c and RBS could be used as inflammatory markers for surgical acute abdomen and its degree of severity, respectively. HbA1c rises in a considerable number of cases with surgical acute abdomen, irrespective of the disease stage. However, as the disease progresses, the random blood sugar rises due to stress hyperglycaemia, thus becoming a surrogate inflammatory marker.
What is already known on this topic? Preoperative stress hyperglycaemia is common in children, and it is linked to adverse postoperative outcomes. HbA1c could be a marker for inflammation and oxidative stress.What does this study add? HbA1c could be an inflammatory marker for surgical acute abdomen, irrespective of the disease stage, as it had a high prevalence in the enrolled children with an acute surgical abdomen. However, as the disease progresses, the random blood sugar rises due to stress hyperglycaemia, thus becoming a surrogate inflammatory marker, as there is a significant correlation between it and the TLC.How might this study affect research, practice, or policy? The novelty in this study centers around the role of glucose metabolism, as evaluated by random blood sugar and HBA1c, in the diagnostic evaluation and prognostication of inflammation, represented by the surgical acute abdomen. This may invite further research into understanding the underlining mechanisms. The outcome of the clinical management of conditions involving inflammation can be improved by using the proposed biomarkers, as peri/preoperative hyperglycaemia could lead to morbidity and mortality, consequently, as proven, the reliability of those biomarkers facilitates risk assessment and stratification. As both tests are cost-effective and universally available, they can be readily implemented in practice guidelines and departmental policies.
This is a cross-sectional study. Non-diabetic paediatric patients with acute surgical abdomen, presenting to the emergency surgical services were enrolled, over a period of 6 months. They were all screened for their random blood sugar and HbA1c levels.
Fifty-three cases were studied. The prevalence of glycaemic dysregulation in the enrolled children was high. Abnormal HbA1c was observed in 66% of the study group. Stress hyperglycaemia was observed in 60% of the enrolled children. There was a significant correlation (r = 0.770, p-value: < 0.001) between RBS and the total leucocytic count (TLC). The TLC cutoff value for predicting stress hyperglycaemia was 13,595 cells/mm3. The cutoff value of RBS for predicting leukocytosis was 111.5 mg/dl. Median RBS level was significantly higher in complicated appendicitis (169.5 mg/dl), compared to uncomplicated appendicitis (118.0 mg/dl).
HbA1c and RBS could be used as inflammatory markers for surgical acute abdomen and its degree of severity, respectively. HbA1c rises in a considerable number of cases with surgical acute abdomen, irrespective of the disease stage. However, as the disease progresses, the random blood sugar rises due to stress hyperglycaemia, thus becoming a surrogate inflammatory marker.
What is already known on this topic? Preoperative stress hyperglycaemia is common in children, and it is linked to adverse postoperative outcomes. HbA1c could be a marker for inflammation and oxidative stress.What does this study add? HbA1c could be an inflammatory marker for surgical acute abdomen, irrespective of the disease stage, as it had a high prevalence in the enrolled children with an acute surgical abdomen. However, as the disease progresses, the random blood sugar rises due to stress hyperglycaemia, thus becoming a surrogate inflammatory marker, as there is a significant correlation between it and the TLC.How might this study affect research, practice, or policy? The novelty in this study centers around the role of glucose metabolism, as evaluated by random blood sugar and HBA1c, in the diagnostic evaluation and prognostication of inflammation, represented by the surgical acute abdomen. This may invite further research into understanding the underlining mechanisms. The outcome of the clinical management of conditions involving inflammation can be improved by using the proposed biomarkers, as peri/preoperative hyperglycaemia could lead to morbidity and mortality, consequently, as proven, the reliability of those biomarkers facilitates risk assessment and stratification. As both tests are cost-effective and universally available, they can be readily implemented in practice guidelines and departmental policies.
摘要：
■血糖失调会增强促炎反应并增加氧化损伤；因此，术前高血糖与死亡率增加有关.此外,炎症伴随着更高的糖化血红蛋白（HbA1c）水平，与随机血糖（RBS）之间的关系可能是非线性的。
■这是一项横断面研究。非糖尿病儿科急腹症患者，向紧急外科服务机构提交的报告被登记，为期6个月。他们都接受了随机血糖和HbA1c水平的筛查。
■研究了53例。入选儿童中血糖失调的患病率很高。66％的研究组观察到HbA1c异常。在60％的入选儿童中观察到应激性高血糖。RBS与总白细胞计数（TLC）之间存在显着相关性（r=0.770，p值：<0.001）。预测应激性高血糖的TLC截断值为13,595个细胞/mm3。预测白细胞增多的RBS截断值为111.5mg/dl。复杂性阑尾炎患者的中位RBS水平明显升高（169.5mg/dl），与单纯性阑尾炎（118.0mg/dl）相比。
■HbA1c和RBS可作为外科急腹症的炎症标志物及其严重程度，分别。在相当多的外科急腹症病例中，HbA1c升高，无论疾病阶段如何。然而,随着疾病的进展，应激性高血糖导致随机血糖升高,从而成为替代炎症标志物。
关于这个话题已经知道了什么？术前应激性高血糖在儿童中很常见，它与术后不良结局有关。HbA1c可能是炎症和氧化应激的标志物。这项研究增加了什么？HbA1c可能是外科急腹症的炎症标志物，无论疾病阶段如何，因为它在纳入的急性外科腹部患儿中患病率很高。然而,随着疾病的进展，应激性高血糖导致随机血糖升高,从而成为替代的炎症标志物，因为它与TLC之间存在显著的相关性。这项研究如何影响研究，实践,还是政策？这项研究的新颖性集中在葡萄糖代谢的作用上，通过随机血糖和HBA1c评估，在炎症的诊断评估和预后中，以外科急腹症为代表。这可能会要求进一步研究了解强调机制。通过使用提出的生物标志物，可以改善涉及炎症的疾病的临床管理的结果。因为围/术前高血糖可能导致发病率和死亡率，因此,如证明,这些生物标志物的可靠性有助于风险评估和分层.由于这两种测试都具有成本效益且普遍可用，它们可以很容易地在实践指南和部门政策中实施。
■这是一项横断面研究。非糖尿病儿科急腹症患者，向紧急外科服务机构提交的报告被登记，为期6个月。他们都接受了随机血糖和HbA1c水平的筛查。
■研究了53例。入选儿童中血糖失调的患病率很高。66％的研究组观察到HbA1c异常。在60％的入选儿童中观察到应激性高血糖。RBS与总白细胞计数（TLC）之间存在显着相关性（r=0.770，p值：<0.001）。预测应激性高血糖的TLC截断值为13,595个细胞/mm3。预测白细胞增多的RBS截断值为111.5mg/dl。复杂性阑尾炎患者的中位RBS水平明显升高（169.5mg/dl），与单纯性阑尾炎（118.0mg/dl）相比。
■HbA1c和RBS可作为外科急腹症的炎症标志物及其严重程度，分别。在相当多的外科急腹症病例中，HbA1c升高，无论疾病阶段如何。然而,随着疾病的进展，应激性高血糖导致随机血糖升高,从而成为替代炎症标志物。
关于这个话题已经知道了什么？术前应激性高血糖在儿童中很常见，它与术后不良结局有关。HbA1c可能是炎症和氧化应激的标志物。这项研究增加了什么？HbA1c可能是外科急腹症的炎症标志物，无论疾病阶段如何，因为它在纳入的急性外科腹部患儿中患病率很高。然而,随着疾病的进展，应激性高血糖导致随机血糖升高,从而成为替代的炎症标志物，因为它与TLC之间存在显著的相关性。这项研究如何影响研究，实践,还是政策？这项研究的新颖性集中在葡萄糖代谢的作用上，通过随机血糖和HBA1c评估，在炎症的诊断评估和预后中，以外科急腹症为代表。这可能会要求进一步研究了解强调机制。通过使用提出的生物标志物，可以改善涉及炎症的疾病的临床管理的结果。因为围/术前高血糖可能导致发病率和死亡率，因此,如证明,这些生物标志物的可靠性有助于风险评估和分层.由于这两种测试都具有成本效益且普遍可用，它们可以很容易地在实践指南和部门政策中实施。
