Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Am J Med. 2011 Nov;124(11):1028-35. doi: 10.1016/j.amjmed.2011.07.011.
Although tight glucose control is used widely in hospitalized patients, there is concern that medication-induced hypoglycemia may worsen patient outcomes. We sought to determine if the mortality risk associated with hypoglycemia in hospitalized noncritically ill patients is linked to glucose-lowering medications (drug-associated hypoglycemia) or merely an association mediated by comorbidities (spontaneous hypoglycemia).
A retrospective cohort of patients admitted to the general wards of an academic center during 2007 was studied. The in-hospital mortality risk of a hypoglycemic group (at least 1 blood glucose ≤ 70 mg/dL) was compared with that of a normoglycemic group using survival analysis. Stratification by subgroups of patients with spontaneous and drug-associated hypoglycemia was performed.
Among 31,970 patients, 3349 (10.5%) had at least 1 episode of hypoglycemia. Patients with hypoglycemia were older, had more comorbidities, and received more antidiabetic agents. Hypoglycemia was associated with increased in-hospital mortality (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.33-2.09; P<.001). However, this greater risk was limited to patients with spontaneous hypoglycemia (HR, 2.62; 95% CI, 1.97-3.47; P<.001) and not to patients with drug-associated hypoglycemia (HR, 1.06; 95% CI, 0.74-1.52; P=.749). After adjustment for patient comorbidities, the association between spontaneous hypoglycemia and mortality was eliminated (HR, 1.11; 95% CI, 0.76-1.64; P=.582).
Drug-associated hypoglycemia was not associated with increased mortality risk in patients admitted to the general wards. The association between spontaneous hypoglycemia and mortality was eliminated after adjustment for comorbidities, suggesting that hypoglycemia may be a marker of disease burden rather than a direct cause of death.
尽管在住院患者中广泛使用严格的血糖控制，但人们担心药物引起的低血糖可能会使患者的预后恶化。我们试图确定住院非危重症患者的低血糖相关死亡率是否与降血糖药物有关（药物相关低血糖），或者仅仅是由合并症介导的关联（自发性低血糖）。
对 2007 年期间入住学术中心普通病房的患者进行回顾性队列研究。使用生存分析比较低血糖组（至少 1 次血糖≤70mg/dL）和正常血糖组的院内死亡率风险。对自发性和药物相关低血糖患者的亚组进行分层。
在 31970 名患者中，有 3349 名（10.5%）至少发生过 1 次低血糖。低血糖患者年龄较大，合并症较多，接受的降糖药物也较多。低血糖与住院期间死亡率增加相关（危险比[HR]，1.67；95%置信区间[CI]，1.33-2.09；P<.001）。然而，这种更高的风险仅限于自发性低血糖患者（HR，2.62；95%CI，1.97-3.47；P<.001），而与药物相关低血糖患者无关（HR，1.06；95%CI，0.74-1.52；P=.749）。在校正患者合并症后，自发性低血糖与死亡率之间的关联被消除（HR，1.11；95%CI，0.76-1.64；P=.582）。
在入住普通病房的患者中，药物相关低血糖与死亡率增加无关。在校正合并症后，自发性低血糖与死亡率之间的关联被消除，这表明低血糖可能是疾病负担的标志物，而不是直接导致死亡的原因。
