Servicio de Medicina Interna, Hospital de Mostoles, Madrid, Spain.
Crit Care Med. 2010 Mar;38(3):849-54. doi: 10.1097/CCM.0b013e3181ce49cf.
To investigate glycemic dynamics and its relation with mortality in critically ill patients. We searched for differences in complexity of the glycemic profile between survivors and nonsurvivors in patients admitted to a multidisciplinary intensive care unit.
Prospective, observational study, convenience sample.
Multidisciplinary intensive care unit of a teaching hospital in Madrid, Spain.
A convenience sample of 42 patients, aged 29 to 86 yrs, admitted to an intensive care unit with an Acute Physiology and Chronic Health Evaluation II score of >or=14 and with an anticipated intensive care unit stay of >72 hrs.
A continuous glucose monitoring system was used to measure subcutaneous interstitial fluid glucose levels every 5 mins for 48 hrs during the first days of intensive care unit stay. A 24-hr period (n = 288 measurements) was used as time series for complexity analysis of the glycemic profile.
Complexity of the glycemic profile was evaluated by means of detrended fluctuation analysis. Other conventional measurements of variability (range, sd, and Mean Amplitude of Glycemic Excursions) were also calculated.
Ten patients died during their intensive care unit stay. Glycemic profile was significantly more complex (lower detrended fluctuation analysis) in survivors (mean detrended fluctuation analysis, 1.49; 95% confidence interval, 1.44-1.53) than in nonsurvivors (1.60; 95% confidence interval, 1.52-1.68). This difference persisted after accounting for the presence of diabetes. In a logistic regression model, the odds ratio for death was 2.18 for every 0.1 change in detrended fluctuation analysis.Age, gender, Simplified Acute Physiologic Score 3 or Acute Physiologic and Chronic Health Evaluation II scores failed to explain differences in survivorship. Conventional variability measurements did not differ between survivors and nonsurvivors.
Complexity of the glycemic profile of critically ill patients varies significantly between survivors and nonsurvivors. Loss of complexity in glycemia time series, evaluated by detrended fluctuation analysis, is associated with higher mortality.
研究危重病患者的血糖动力学及其与死亡率的关系。我们在入住多学科重症监护病房的患者中寻找幸存者和非幸存者之间血糖谱复杂性的差异。
前瞻性、观察性研究，方便样本。
西班牙马德里一所教学医院的多学科重症监护病房。
入住重症监护病房的 42 例患者，年龄 29 至 86 岁，急性生理学和慢性健康评估 II 评分>14，预计重症监护病房入住时间>72 小时。
入住重症监护病房的头几天，使用连续血糖监测系统每 5 分钟测量一次皮下间质液葡萄糖水平，持续 48 小时。将 24 小时期间（n=288 次测量）用作血糖谱复杂性时间序列分析的时间序列。
血糖谱的复杂性通过去趋势波动分析进行评估。还计算了其他常规变异性测量值（范围、标准差和平均血糖波动幅度）。
10 名患者在重症监护病房期间死亡。幸存者（平均去趋势波动分析，1.49；95%置信区间，1.44-1.53）的血糖谱明显更为复杂（去趋势波动分析较低），而非幸存者（1.60；95%置信区间，1.52-1.68）。在考虑到糖尿病的存在后，这种差异仍然存在。在逻辑回归模型中，去趋势波动分析每变化 0.1，死亡的优势比为 2.18。年龄、性别、简化急性生理学评分 3 分或急性生理学和慢性健康评估 II 评分未能解释存活率的差异。幸存者和非幸存者之间的常规变异性测量值没有差异。
危重病患者血糖谱的复杂性在幸存者和非幸存者之间有显著差异。去趋势波动分析评估的血糖时间序列复杂性丧失与死亡率升高相关。
