Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, CO, USA.
Crit Care Med. 2010 Jan;38(1):16-24. doi: 10.1097/CCM.0b013e3181b9eaa5.
Chronic diabetes mellitus (DM) is a known cause of multisystem injury. The effect of DM in acute critical illness may also be detrimental, but is not specifically known. We hypothesized that the preexisting diagnosis of DM is an independent risk factor for mortality in critically ill patients.
Parallel retrospective and prospective cohort study.
Two large patient datasets were used: the retrospective University HealthSystem Consortium database (UHC) and the prospective Mayo Clinic Acute Physiology And Chronic Health Evaluation III critical care database (Mayo).
Inclusion criteria were admission to an intensive care unit and age > or =18 yrs. Patients with diabetic ketoacidosis or hyperosmolar nonketotic coma were excluded. A total of 1,509,890 patients (including 143,078 deaths) in the UHC cohort and 36,414 patients (including 3562 deaths) in the Mayo cohort were included in the study analysis.
The primary outcome was in-hospital mortality compared between patients with a history of DM and all other patients. Other outcomes included in-hospital mortality in prespecified subgroups. In the UHC dataset, patients with DM had a lower unadjusted odds ratio (0.90, 95% confidence interval 0.89-0.91, p < .001) and a lower adjusted effect on mortality (odds ratio 0.75, 0.74-0.76, p < .001) compared with that seen in patients without DM. In the Mayo dataset, patients with DM had a comparable unadjusted odds ratio (1.07, 0.97-1.17, p = NS) and a lower adjusted effect on mortality (odds ratio 0.88, 0.79-0.98, p = .022) compared with that seen in patients without DM. A lower mortality in diabetic patients held across multiple demographic subgroups, including patients who underwent coronary-artery bypass grafting (UHC data: unadjusted odds ratio 0.66, 0.62-0.71, p < .001).
Critically ill adults with DM do not have an increased mortality compared with that seen in patients without DM, and may have a decreased mortality. Further investigation needs to be done to determine the mechanism for this effect.
慢性糖尿病（DM）是多系统损伤的已知原因。DM 在急性危重病中的影响也可能是有害的，但具体情况尚不清楚。我们假设预先存在的 DM 诊断是危重病患者死亡的独立危险因素。
平行回顾性和前瞻性队列研究。
使用了两个大型患者数据集：回顾性的大学健康联盟数据库（UHC）和前瞻性的梅奥诊所急性生理学和慢性健康评估 III 重症监护数据库（Mayo）。
纳入标准为入住重症监护病房和年龄≥18 岁。排除糖尿病酮症酸中毒或高渗性非酮症昏迷的患者。UHC 队列共有 1509890 例患者（包括 143078 例死亡），Mayo 队列中有 36414 例患者（包括 3562 例死亡）纳入本研究分析。
主要结局为与无 DM 患者相比，DM 病史患者的院内死亡率。其他结局包括指定亚组的院内死亡率。在 UHC 数据集，DM 患者的未校正比值比（0.90，95%置信区间 0.89-0.91，p<0.001）和校正死亡率效应（比值比 0.75，0.74-0.76，p<0.001）均低于无 DM 患者。在 Mayo 数据集，DM 患者的未校正比值比（1.07，0.97-1.17，p=NS）和校正死亡率效应（比值比 0.88，0.79-0.98，p=0.022）与无 DM 患者相似。在包括接受冠状动脉旁路移植术的患者在内的多个人口统计学亚组中，糖尿病患者的死亡率均较低（UHC 数据：未校正比值比 0.66，0.62-0.71，p<0.001）。
与无 DM 患者相比，危重症成年糖尿病患者的死亡率没有增加，甚至可能降低。需要进一步研究以确定这种影响的机制。
