Cai Yan, Ma Gui, Jin Zhao-chen, Zhang Wen-bo, Jiang Peng-cheng
Department of Critical Care Medicine, Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China.
Zhonghua Yi Xue Za Zhi. 2011 Nov 1;91(40):2853-7.
To access the predictive values of glycemic lability index (GLI) as an indicator of glucose variability in the prognosis of critically ill patients.
A prospective study of 72 critically ill patients admitted into intensive care unit (ICU) were performed. Capillary glucose was measured on admission and every 2 hrs afterward during the first 24 hrs. GLI, mean amplitude of glycemic excursion (MAGE), largest amplitude of glycemic excursions (LAGE), mean, standard deviation (SD) and coefficient of variability (CV) were calculated respectively. The 30 day mortality was selected as the end-point. Receiver operating curve (ROC) was drawn to explore the association between each indicator of glucose variability and prognosis. The subjects were subsequently divided into 4 subgroups according to the median of mean and GLI. The 30-day mortality was then compared between the subgroups.
Thirty-one of 72 patients died with a mortality rate of 43.1%. The area under the curve (AUC) of GLI (0.798 ± 0.051) was superior to that of MAGE (0.785 ± 0.053), LAGE (0.772 ± 0.056), SD (0.761 ± 0.056), CV (0.729 ± 0.059) and mean (0.670 ± 0.065) under the determination of ROC respectively. GLI was significantly correlated with APACHE II (acute physiology and chronic health evaluation II) score assessed during the first 24 hrs after admission (R(2) = 0.787, P < 0.001). With the rise of GLI value, the 30-day mortality also increased gradually. Subgroup analysis demonstrated that the duration of mechanical ventilation, the incidence of multiple organ failure (MOF), the utilization rate of CRRT (continuous renal replacement therapy), the staying length of ICU and the 30 mortality rate was (3.3 ± 4.4) d, 41.6%, 12.5%, (4.6 ± 4.5) d and 16.7% respectively in the low mean +low GLI subgroup. They decreased obviously compared to the low mean +high GLI, high mean +low GLI and high mean +high GLI groups. Therefore the low mean +low GLI subgroup had the best prognosis while the high mean +high GLI subgroup worst.
GLI of the first 24 hrs after ICU admission can serve as an indicator of glucose variability. And it is significantly correlated with the patient prognosis.
评估血糖波动指数（GLI）作为葡萄糖变异性指标在危重症患者预后中的预测价值。
对72例入住重症监护病房（ICU）的危重症患者进行前瞻性研究。入院时及之后的头24小时内每2小时测量一次毛细血管血糖。分别计算GLI、血糖波动平均幅度（MAGE）、血糖波动最大幅度（LAGE）、均值、标准差（SD）和变异系数（CV）。选择30天死亡率作为终点。绘制受试者工作特征曲线（ROC）以探讨葡萄糖变异性各指标与预后之间的关联。随后根据均值和GLI的中位数将受试者分为4个亚组。然后比较各亚组之间的30天死亡率。
72例患者中有31例死亡，死亡率为43.1%。在ROC测定中，GLI的曲线下面积（AUC）（0.798±0.051）分别优于MAGE（0.785±0.053）、LAGE（0.772±0.056）、SD（0.761±0.056）、CV（0.729±0.059）和均值（0.670±0.065）。GLI与入院后头24小时内评估的急性生理与慢性健康状况评分II（APACHE II）显著相关（R² = 0.787，P < 0.001）。随着GLI值的升高，30天死亡率也逐渐增加。亚组分析表明，低均值+低GLI亚组的机械通气时间、多器官功能衰竭（MOF）发生率、连续性肾脏替代治疗（CRRT）利用率、ICU住院时间和30天死亡率分别为（3.3±4.4）天、41.6%、12.5%、（4.6±4.5）天和16.7%。与低均值+高GLI、高均值+低GLI和高均值+高GLI组相比，它们明显降低。因此，低均值+低GLI亚组预后最佳，而高均值+高GLI亚组最差。
ICU入院后头24小时的GLI可作为葡萄糖变异性的指标。并且它与患者预后显著相关。
