Pasquel Francisco J, Smiley Dawn, Spiegelman Ronnie, Lin Erica, Peng Limin, Umpierrez Guillermo E
Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
Hosp Pract (1995). 2011 Apr;39(2):81-8. doi: 10.3810/hp.2011.04.397.
Hyperglycemia is a recognized complication of parenteral nutrition (PN). We aimed to determine the impact of hyperglycemia during PN unaccompanied by tight blood glucose (BG) control on hospital complications and mortality.
We reviewed the medical records of 276 medical and surgical patients receiving PN to determine the impact of hyperglycemia on survival after adjusting for known prognostic factors, and to determine whether BG levels before initiation of PN, within 24 hours of PN initiation, or during PN therapy are predictive of adverse outcomes.
A total of 276 medical (35%) and surgical (65%) patients receiving PN initiated 12 ± 12 days after admission for a mean of 15 ± 24 days. Deceased patients (27.2%) were older, had higher Acute Physiology and Chronic Health Evaluation II scores, and had higher BG levels during PN therapy versus survivors (all, P < 0.01). Deceased patients had higher BG levels within 24 hours of PN initiation (162 ± 55 mg/dL vs 139 ± 37 mg/dL; P = 0.003) and higher BG levels during days 2 to 10 of PN (161 ± 53 mg/dL vs 142 ± 34 mg/dL; P = 0.013) compared with survivors. Blood glucose levels were associated with increased odds ratio (OR) for mortality pre-PN (P = 0.008), within 24 hours of PN initiation (P < 0.001), and during days 2 to 10 of PN (P < 0.001). In multiple regression models adjusted for age, sex, and history of diabetes, mortality was independently associated with pre-PN BG levels 121 to 150 mg/dL (OR, 2.2; 95% confidence interval [CI], 1.1-4.4), 151 to 180 mg/dL (OR, 3.41; 95% CI, 1.3-8.7,), and > 180 mg/dL (OR, 2.2; 95% CI, 0.9-5.2), and with BG levels within 24 hours of PN initiation > 180 mg/dL (OR, 2.8; 95% CI, 1.2-6.8). A BG level > 180 mg/dL within 24 hours of PN initiation was associated with increased risk of pneumonia (OR, 3.1; 95% CI, 1.4-7.1) and acute renal failure (OR, 2.3; 95% CI, 1.1-5.0).
Hyperglycemia during PN without tight BG control is associated with increased risk of hospital complications and mortality. Randomized controlled trials are needed to determine benefits of intensified glycemic control on clinical outcomes in hospitalized subjects receiving PN.
高血糖是肠外营养（PN）公认的并发症。我们旨在确定PN期间未进行严格血糖（BG）控制的高血糖对医院并发症和死亡率的影响。
我们回顾了276例接受PN的内科和外科患者的病历，以确定在调整已知预后因素后高血糖对生存的影响，并确定PN开始前、PN开始后24小时内或PN治疗期间的BG水平是否可预测不良结局。
总共276例接受PN的内科（35%）和外科（65%）患者在入院后12±12天开始接受PN，平均持续15±24天。死亡患者（27.2%）年龄更大，急性生理与慢性健康状况评分II更高，与幸存者相比，PN治疗期间的BG水平更高（所有P<0.01）。与幸存者相比，死亡患者在PN开始后24小时内的BG水平更高（162±55mg/dL对139±37mg/dL；P=0.003），在PN第2至10天的BG水平更高（161±53mg/dL对142±34mg/dL；P=0.013）。血糖水平与PN前（P=0.008）、PN开始后24小时内（P<0.001）和PN第2至10天期间（P<0.001）死亡率的比值比（OR）增加相关。在调整年龄、性别和糖尿病史的多因素回归模型中，死亡率与PN前BG水平121至150mg/dL（OR，2.2；95%置信区间[CI]，1.1 - 4.4）、151至180mg/dL（OR，3.41；95%CI，1.3 - 8.7）和>180mg/dL（OR，2.2；95%CI，0.9 - 5.2）以及PN开始后24小时内BG水平>180mg/dL（OR，2.8；95%CI，1.2 - 6.8）独立相关。PN开始后24小时内BG水平>180mg/dL与肺炎风险增加（OR，3.1；95%CI，1.4 - 7.1）和急性肾衰竭风险增加（OR，2.3；95%CI，1.1 - 5.0）相关。
PN期间未进行严格BG控制的高血糖与医院并发症和死亡率风险增加相关。需要进行随机对照试验以确定强化血糖控制对接受PN的住院患者临床结局的益处。
