Assessment of trace elements in critically ill patients with systemic inflammatory response syndrome: A systematic review.

BACKGROUND: Zinc (Zn), copper (Cu), and selenium (Se) are involved in immune and antioxidant defense. Their role in systemic inflammatory response syndrome (SIRS) treatment and outcomes remains unclear. This systematic review aimed to describe trace element concentrations in different types of biological samples and their relationship with morbidity and mortality in patients with SIRS. METHODS: Literature was systematically reviewed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The search results were screened and evaluated for eligibility, and data were extracted and summarized in tables and figures. RESULTS: Most of the 38 included studies evaluated Se (75%), followed by Zn (42%) and Cu (22%). Plasma was the main biological sample evaluated (58%). Thirteen studies found lower plasma/serum concentrations of Zn, Se, and Cu in SIRS patients than in controls upon admission, 11 studies on adults (intensive care unit-ICU) and two in pediatric ICU (PICU). Three ICU studies found no difference in erythrocyte trace element concentrations in patients with SIRS. In all studies, the two main outcomes investigated were organ failure and mortality. In seven ICU studies, patients with lower plasma or serum Zn/Se levels had higher mortality rates. A study conducted in the PICU reported an association between increased Se variation and lower 28-day mortality. In an ICU study, lower erythrocyte selenium levels were associated with higher ICU/hospital mortality, after adjustment. Five ICU studies associated lower plasma/serum Zn/Se levels with higher organ failure scores and one PICU study showed an association between higher erythrocyte Se levels and lower organ dysfunction scores. CONCLUSION: There was no difference in erythrocyte Se levels in patients with SIRS. Serum/Plasma Zn and serum/plasma/erythrocyte Se are associated with organ dysfunction, mortality, and inflammation. Trace element deficiencies should be diagnosed by erythrocyte, or complementary measurements in the presence of inflammation.

Comportamento da variabilidade glicêmica em pacientes hospitalizados com Diabetes Mellitus 2 / Behavior of glycemic variability in hospitalized type 2 Diabetes Mellitus patients / Comportamiento de la variable glucémica en pacientes Hospitalizados con Diabetes Mellitus 2

Introdução: A hiperglicemia pode estar presente em até 38% dos pacientes hospitalizados.O controle glicêmico está associado a melhores desfechos clínicos. Objetivo: avaliar o comportamento da variabilidade glicêmica em pacientes hospitalizados com Diabetes Mellitus 2. Metodologia: Estudo transversal, composto por pacientes hospi-talizados com e sem diabetes, adultos e idosos, de ambos os gêneros, em terapia nutricional enteral. As glicemias foram medidas por testes de glicemia capilar e classificadas como normoglicemia, hiperglicemia e variabilidade glicêmica, avaliados a partir do desvio-padrão glicêmico e coeficiente de variação glicêmico. Foram avaliados dados bioquímicos como Proteína C-reativa. A análise de variância de duas vias (ANOVA) foi utilizada para comparar os grupos, além da correlação de Spearman. Resultados: Participaram 85 indivíduos, com diabetes mellitus 2 (20%; n= 17), e sem diabetes mellitus (80%; n = 68), sendo 34% (n = 29) adultos e 66% (n=56) idosos. Adultos e idosos com diabetes mellitus apresentaram hiperglicemia em relação aos pacientes não diabéticos (p<0,01), valores supe-riores de desvio-padrão glicêmico (p<0,01) e coeficiente de variação glicêmica em relação aos pacientes sem dia-betes (p= 0,03), no entanto, não foram classificados com variabilidade glicêmica. Os valores da Proteína C-reativa foram correlacionados com o desvio-padrão glicêmico (R= 0,29; p= 0,0065), no entanto, a quantidade de carboi-dratos infundida na dieta enteral não se correlacionou estatisticamente com as glicemias nem com a variabilidade glicêmica dos pacientes (p>0,05). Conclusão: pacientes hospitalizados com ou sem diabetes mellitus 2 não apre-sentaram variabilidade glicêmica, demonstrando um controle glicêmico na hospitalização. (AU)

Introduction: Hyperglycemia may be present in up to 38% of hospitalized patients. Glycemic control is associated with better clinical outcomes. Objective: assess the behavior of glycemic variability in hospitalized patients with Diabetes Mellitus 2. Methodology: Cross-sectional study composed of hospitalized patients with and without diabetes, adults and elderly, of both genders, undergoing enteral nutritional therapy. Blood glucose was measured by capillary blood glucose tests and classified as normoglycemia, hyperglycemia, and glycemic variability, assessed from the glycemic standard deviation and glycemic variation coefficient. Biochemical data such as C-reactive protein were assessed. Two-way analysis of variance (ANOVA) was used to compare the groups, in addition to Spearman's correlation. Results: Eighty-five individuals with diabetes mellitus 2 (20%; n=17) and without diabetes mellitus (80%; n=68) participated in the study; 34% (n=29) were adults, and 66% (n=56) were elderly. Adults and elderly people with diabetes mellitus presented hyperglycemia concerning non-diabetic patients (p<0.01), higher values of glycemic standard deviation (p<0.01), and glycemic variation coefficient concerning patients without diabetes (p= 0.03); however, they were not classified with glycemic variability. The C-reactive protein values were correlated with the glycemic standard deviation (R= 0.29; p= 0.0065); however, the amount of carbohydrates infused in the enteral diet was not statistically correlated with glycemia or with the glycemic variability of patients (p>0.05). Conclusion: hospitalized patients with or without diabetes mellitus 2 did not show glycemic variability, demonstrating glycemic control during hospitalization. (AU)

Introducción: La hiperglucemia puede estar presente hasta en un 38% de los pacientes hospitalizados. El con-trol glucémico se asocia con mejores resultados clínicos. Objetivo: evaluar el comportamiento de la variación glucémica en pacientes con Diabetes Mellitus 2. Metodología: Estudio transversal, compuesto por pacientes hos-pitalizados con y sin diabetes, adultos y ancianos, con terapia nutricional enteral. Las glucemias fueron medidas por exámenes de glucemia capilar y clasificadas como normo glucemia, hiperglucemia y variación glucémica, evaluados a partir de la desviación estándar y coeficiente de variación glucémico. Fueron evaluados datos bioquí-micos como Proteína C-reactiva. El análisis de la variación de las dos vías (ANOVA) fue utilizada para comparar los grupos, junto a la correlación de Spearman. Resultados: Participaron 85 individuos, con diabetes mellitus 2 (20%; n+17), y sin diabetes mellitus (80%; n = 68). Adultos 34% (n=29) y ancianos 66% (n=56). Pacientes con diabetes mellitus presentaron hiperglucemia en relación a los pacientes nodiabéticos (p< 0,01), valores superiores de desviación estándar glucémico (p< 0,01) y coeficiente de variación glucémica en relación a los pacientes sin dia-betes (p= 0,03), sin embargo, no fueron clasificados con variación glucémica. Los valores de la Proteína C-reactiva fueron correlacionados con la desviación estándar glucémica (R = 0,29; P= 0,0065), la cantidad de carbohidratos administrada, no se correlacionó estadísticamente con las glucemias ni con la variación glucémica de los pacientes (p>0,05). Conclusión: pacientes hospitalizados con o sin diabetes mellitus 2 no presentaron variación glucémica, demostrando control glucémico en la hospitalización. (AU)