Yendamuri Saikrishna, Fulda Gerard J, Tinkoff Glen H
Department of Surgery, Christian Care Health Services, Newark, Delaware, USA.
J Trauma. 2003 Jul;55(1):33-8. doi: 10.1097/01.TA.0000074434.39928.72.
The purpose of this study was to assess the utility of two levels of hyperglycemia as predictors for mortality and infectious morbidity in traumatically injured patients.
All patients >or= 17 years old presenting to a Level I trauma center as a "trauma alert" or a "trauma code" from January 1, 2000, through December 31, 2000, were reviewed. Hypoglycemic patients (glucose concentration < 70 mg/dL) were excluded (n = 4). Patients were considered hyperglycemic with an admission glucose concentration > 200 mg/dL (moderate hyperglycemia) or an admission glucose concentration in the upper quartile for the group (mild hyperglycemia [glucose concentration > 135 mg/dL]).
Seven hundred thirty-eight patients were included in the study. Hyperglycemia was associated with increased mortality among both patients with moderate hyperglycemia (34.1% vs. 3.7%, p < 0.01) and those with mild hyperglycemia (15.5% vs. 2%, p < 0.01) compared with corresponding normoglycemic groups. Hyperglycemia proved to be an independent predictor of mortality and of hospital and intensive care unit length of stay after multiple logistic regression while controlling for age, Injury Severity Score, Revised Trauma Score, and gender. Infectious complications, including pneumonia (9.4% vs. 2%, p = 0.001), urinary tract infections (6.6% vs. 1.4%, p = 0.001), wound infections (4.9% vs. 0.6%, p = 0.039), and bacteremia (5% vs. 1.1%, p = 0.004), were significantly increased in patients with elevated glucose concentrations. Hyperglycemia is an independent predictor of increased infectious morbidity controlling for age, gender, and Injury Severity Score in multiple logistic regression models.
Hyperglycemia independently predicts increased intensive care unit and hospital length of stay and mortality in the trauma population. It is associated with increased infectious morbidity. These associations hold true for mild hyperglycemia (glucose concentration > 135 mg/dL) and moderate hyperglycemia (glucose concentration > 200 mg/dL).
本研究旨在评估两个血糖水平对创伤患者死亡率和感染性并发症的预测价值。
回顾了2000年1月1日至2000年12月31日期间，以“创伤警报”或“创伤代码”形式送至一级创伤中心的所有17岁及以上患者。低血糖患者（血糖浓度<70mg/dL）被排除（n = 4）。入院血糖浓度>200mg/dL（中度高血糖）或处于该组上四分位数（轻度高血糖[血糖浓度>135mg/dL]）的患者被视为高血糖患者。
738例患者纳入本研究。与相应的正常血糖组相比，中度高血糖患者（34.1%对3.7%，p<0.01）和轻度高血糖患者（15.5%对2%，p<0.01）的高血糖与死亡率增加相关。在多因素logistic回归分析中，校正年龄、损伤严重度评分、修订创伤评分和性别后，高血糖被证明是死亡率、住院时间和重症监护病房住院时间的独立预测因素。血糖浓度升高的患者感染并发症显著增加，包括肺炎（9.4%对2%，p = 0.001）、尿路感染（6.6%对1.4%，p = 0.001）、伤口感染（4.9%对0.6%，p = 0.039）和菌血症（5%对1.1%，p = 0.004）。在多因素logistic回归模型中，校正年龄、性别和损伤严重度评分后，高血糖是感染性并发症增加的独立预测因素。
高血糖独立预测创伤患者重症监护病房和住院时间延长及死亡率增加。它与感染性并发症增加相关。这些关联在轻度高血糖（血糖浓度>135mg/dL）和中度高血糖（血糖浓度>200mg/dL）中均成立。
