Ali Naeem A, O'Brien James M, Blum William, Byrd John C, Klisovic Rebecca B, Marcucci Guido, Phillips Gary, Marsh Clay B, Lemeshow Stanley, Grever Michael R
Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Ohio State University, Columbus, Ohio 43210, USA.
Cancer. 2007 Jul 1;110(1):96-102. doi: 10.1002/cncr.22777.
Hyperglycemia is often observed in medically ill patients. Previous studies have shown that patients with hyperglycemia during induction therapy for acute lymphoblastic leukemia develop more infections and have shorter disease-free survival. The authors hypothesized that hyperglycemia may be associated with adverse outcomes in patients with acute myeloid leukemia (AML) and sought to determine whether this association exists in this population.
The authors performed a retrospective cohort study to examine the relation between hyperglycemia and hospital mortality in patients with the diagnosis of AML. Two hundred eighty-three adult patients were treated over a 3-year period. All hospitalizations were reviewed during the study period, and glucose exposure and outcomes were quantified.
Hyperglycemia during a patient's hospitalization was associated with increased hospital mortality (OR, 1.38; 95% CI, 1.23-1.55; P < .001) after adjusting for covariates, including disease state, treatment type, and response. The rise in mortality was evident at even mild levels (110-150 mg/dL) of glucose elevation. Although the odds of developing severe sepsis (OR, 1.24; 95% CI, 1.13.-1.38; P < .001) or severe sepsis with respiratory failure (OR, 2.04; 95% CI, 1.44-2.91; P < .001) were increased with hyperglycemia, sepsis did not appear to be the main factor responsible for the negative impact of hyperglycemia on hospital mortality.
This study demonstrated an association between hospital mortality and even modest levels of hyperglycemia in AML patients. Prospective studies are needed to confirm this association and to discern causal pathways that mediate this effect.
在患有内科疾病的患者中常观察到高血糖。既往研究表明，急性淋巴细胞白血病诱导治疗期间出现高血糖的患者发生更多感染且无病生存期更短。作者推测高血糖可能与急性髓系白血病（AML）患者的不良预后相关，并试图确定这种关联在该人群中是否存在。
作者进行了一项回顾性队列研究，以检查AML诊断患者中高血糖与医院死亡率之间的关系。在3年期间治疗了283例成年患者。在研究期间对所有住院情况进行了回顾，并对葡萄糖暴露情况和结局进行了量化。
在调整协变量（包括疾病状态、治疗类型和反应）后，患者住院期间的高血糖与医院死亡率增加相关（OR，1.38；95%CI，1.23 - 1.55；P <.001）。即使在血糖轻度升高（110 - 150 mg/dL）时死亡率的上升也很明显。尽管高血糖会增加发生严重脓毒症（OR，1.24；95%CI，1.13 - 1.38；P <.001）或伴有呼吸衰竭的严重脓毒症（OR，2.04；95%CI，1.44 - 2.91；P <.001）的几率，但脓毒症似乎并不是高血糖对医院死亡率产生负面影响的主要因素。
本研究表明AML患者的医院死亡率与即使适度的高血糖水平之间存在关联。需要进行前瞻性研究来证实这种关联并识别介导这种效应的因果途径。
