Perioperative tight glycemic control using artificial pancreas decreases infectious complications via suppression of inflammatory cytokines in patients who underwent pancreaticoduodenectomy: A prospective, non-randomized clinical trial
Autor: | Yasuyuki Tsujita, Yutaka Eguchi, Masaji Tani, Yasuhiko Imashuku, Naomi Kitamura, Hiroya Akabori, Hiromitsu Maehira, Tomoharu Shimizu, Hirotoshi Kitagawa |
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Rok vydání: | 2020 |
Předmět: |
Blood Glucose
Male Pancreas Artificial medicine.medical_specialty medicine.medical_treatment Artificial pancreas 030204 cardiovascular system & hematology Gastroenterology Perioperative Care Pancreaticoduodenectomy law.invention Tight glycemic control Diabetes Complications Impaired glucose tolerance 03 medical and health sciences Postoperative Complications 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Clinical endpoint Humans Hypoglycemic Agents Insulin Surgical Wound Infection Prospective Studies Aged Glycemic Adiponectin business.industry General Medicine Perioperative Middle Aged medicine.disease Adipose Tissue 030220 oncology & carcinogenesis Cytokines Female Surgery Inflammation Mediators business |
Zdroj: | The American Journal of Surgery. 220:365-371 |
ISSN: | 0002-9610 |
DOI: | 10.1016/j.amjsurg.2019.12.008 |
Popis: | BACKGROUND:We sought to investigate the efficacy of perioperative tight glycemic control (TGC) in reducing of postoperative infectious complications (POICs) and study its impact on early inflammatory mediators in patients who underwent pancreaticoduodenectomy. METHODS:In this non-randomized trial, the artificial pancreas (AP) group received TGC (target glucose range of 80-110mg/dL; n=14), while the control group received conventional glycemic control (range of 80-180mg/dL; n=15). The primary endpoint was POICs. RESULTS:The AP group had a markedly decreased POIC rate (28.6% vs. 73.3%; P= 0.027), mean glycemic variability (13.5±3.5% vs. 16.4±5.9%; P=0.038), and plasma interleukin-6 level (26.3±33.8 vs 98.3±89.1pg/ml; P=0.036) compared to the control group, but insulin dosage (27.0±13.4 vs. 10.2±16.2 U; P=0.002) and the adiponectin ratio (i.e., postoperative/preoperative adiponectin; 0.8±0.2 vs. 0.6±0.3; P=0.021) were markedly higher in the AP group. CONCLUSIONS:Among patients undergoing PD with impaired glucose tolerance, AP facilitated strict glycemic control and resulted in a reduction of anti-inflammatory mediators and POICs. SUMMARY:Perioperative hyperglycemia increases postoperative infectious complications; however, tight glycemic control using artificial pancreas can reduce them via a dual effect. Artificial pancreas facilitates strict and safe glycemic control while reducing anti-inflammatory mediators, including adiponectin, following pancreaticoduodenectomy. |
Databáze: | OpenAIRE |
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