Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgium.
Crit Care. 2010;14(1):R12. doi: 10.1186/cc8866. Epub 2010 Feb 4.
This was a planned substudy from the European observational Sepsis Occurrence in Acutely ill Patients (SOAP) study to investigate the possible impact of insulin-treated diabetes on morbidity and mortality in ICU patients.
The SOAP study was a cohort, multicenter, observational study which included data from all adult patients admitted to one of 198 participating ICUs from 24 European countries during the study period. For this substudy, patients were classified according to whether or not they had a known diagnosis of insulin-treated diabetes mellitus. Outcome measures included the degree of organ dysfunction/failure as assessed by the sequential organ failure assessment (SOFA) score, the occurrence of sepsis syndromes and organ failure in the ICU, hospital and ICU length of stay, and all cause hospital and ICU mortality.
Of the 3147 patients included in the SOAP study, 226 (7.2%) had previously diagnosed insulin-treated diabetes mellitus. On admission, patients with insulin-treated diabetes were older, sicker, as reflected by higher simplified acute physiology system II (SAPS II) and SOFA scores, and more likely to be receiving hemodialysis than the other patients. During the ICU stay, more patients with insulin-treated diabetes required renal replacement therapy (hemodialysis or hemofiltration) than other patients. There were no significant differences in ICU or hospital lengths of stay or in ICU or hospital mortality between patients with or without insulin-treated diabetes. Using a Cox proportional hazards regression analysis with hospital mortality censored at 28-days as the dependent factor, insulin-treated diabetes was not an independent predictor of mortality.
Even though patients with a history of insulin-treated diabetes are more severely ill and more likely to have renal failure, insulin-treated diabetes is not associated with increased mortality in ICU patients.
这是欧洲观察性急性病患者中发生的脓毒症（SOAP）研究的一项计划子研究，旨在研究胰岛素治疗的糖尿病对 ICU 患者发病率和死亡率的可能影响。
SOAP 研究是一项队列、多中心、观察性研究，纳入了来自 24 个欧洲国家的 198 个参与 ICU 的所有成年患者的数据。对于本子研究，根据患者是否有明确的胰岛素治疗糖尿病诊断进行分类。结局指标包括通过序贯器官衰竭评估（SOFA）评分评估的器官功能障碍/衰竭程度、ICU 中脓毒症综合征和器官衰竭的发生、ICU 和医院住院时间以及全因 ICU 和医院死亡率。
在 SOAP 研究中纳入的 3147 例患者中，226 例（7.2%）有明确诊断的胰岛素治疗糖尿病。入院时，与其他患者相比，接受胰岛素治疗的糖尿病患者年龄更大、病情更重，表现为简化急性生理学评分系统 II（SAPS II）和 SOFA 评分更高，更有可能接受血液透析治疗。在 ICU 住院期间，更多接受胰岛素治疗的糖尿病患者需要肾脏替代治疗（血液透析或血液滤过）。接受胰岛素治疗的糖尿病患者与未接受胰岛素治疗的糖尿病患者在 ICU 或医院住院时间或 ICU 或医院死亡率方面无显著差异。使用 Cox 比例风险回归分析，将 28 天的 ICU 死亡率作为因变量，胰岛素治疗的糖尿病不是死亡率的独立预测因素。
尽管有胰岛素治疗糖尿病史的患者病情更严重，更有可能发生肾衰竭，但胰岛素治疗的糖尿病与 ICU 患者死亡率增加无关。
