Department of Research and Product Marketing, Philips Healthcare, Baltimore, MD, USA. omar.
Crit Care Med. 2012 Dec;40(12):3180-8. doi: 10.1097/CCM.0b013e3182656ae5.
Our objective was to quantify the association between intensive care unit-acquired dysglycemia (hyperglycemia, hypoglycemia, and high variability) and in-hospital mortality.
Retrospective, observational study.
eICU Research Institute participating hospitals with an active tele-ICU program between January 1, 2008, and September 30, 2010, representing 784,392 adult intensive care unit patients.
A total of 194,772 patients met inclusion criteria with an intensive care unit length of stay >48 hrs.
None.
Acute Physiology and Chronic Health Evaluation IV standardized mortality ratios were calculated for dysglycemia present at admission and acquired in the intensive care unit. Intensive care unit-acquired dysglycemia was modeled using multivariable modified Poisson regression to account for confounding not incorporated in Acute Physiology and Chronic Health Evaluation. Dysglycemia severity was assessed by the relative risk of in-hospital mortality associated with the maximum, time-weighted average daily glucose; lowest glucose value throughout the intensive care unit stay; and quintiles of variability (coefficient of variation). The association of duration beyond thresholds of dysglycemia on mortality was also modeled. The adjusted relative risk (95% confidence interval) of mortality for the maximum intensive care unit average daily glucose was 1.13 (1.04-1.58), 1.43 (1.30-1.58), 1.63 (1.47-1.81), 1.76 (1.55-1.99), and 1.89 (1.62-2.19) for 110-150 mg/dL, 151-180 mg/dL, 180-240 mg/dL, 240-300 mg/dL, and >300 mg/dL, respectively, compared to patients whose highest average daily glucose was 80-110 mg/dL. The relative risk of mortality for the lowest glucose value was 1.67 (1.37-2.03), 1.53 (1.37-1.70), 1.12 (1.04-1.21), and 1.06 (1.01-1.11) for <20 mg/dL, 20-40 mg/dL, 40-60 mg/dL, and 60-80 mg/dL, respectively, compared to patients whose lowest value was 80-110 mg/dL. The relative risk of mortality increased with greater duration of hyperglycemia and with increased variability. The relative risk for the highest compared to lowest quintile of variability was 1.61 (1.47-1.78). The association of duration of hyperglycemia on mortality was more pronounced with more severe hyperglycemia.
The risk of mortality progressively increased with severity and duration of deviation from euglycemia and with increased variability. These data suggest that severe intensive care unit-acquired hyperglycemia, hypoglycemia, and variability are associated with similar risks of mortality.
本研究旨在量化重症监护病房获得性血糖异常（高血糖、低血糖和高变异性）与院内死亡率之间的关联。
回顾性、观察性研究。
eICU 研究学会参与的医院，其在 2008 年 1 月 1 日至 2010 年 9 月 30 日期间有一个活跃的远程重症监护项目，代表了 784392 名成年重症监护病房患者。
共有 194772 名符合纳入标准的患者，重症监护病房入住时间>48 小时。
无。
急性生理学和慢性健康评估 IV 标准化死亡率比用于评估入院时和重症监护病房获得的血糖异常。采用多变量修正泊松回归模型对重症监护病房获得性血糖异常进行建模，以解释急性生理学和慢性健康评估未纳入的混杂因素。通过与院内死亡率相关的最大、时间加权平均每日血糖、整个重症监护病房期间的最低血糖值以及变异性（变异系数）五分位数来评估血糖异常的严重程度。还对血糖异常持续时间超过阈值与死亡率的关系进行了模型分析。最高重症监护病房平均每日血糖的调整后相对风险（95%置信区间）分别为 1.13（1.04-1.58）、1.43（1.30-1.58）、1.63（1.47-1.81）、1.76（1.55-1.99）和 1.89（1.62-2.19），与最高平均每日血糖为 110-150mg/dL、151-180mg/dL、180-240mg/dL、240-300mg/dL 和>300mg/dL 的患者相比。最低血糖值的死亡相对风险为 1.67（1.37-2.03）、1.53（1.37-1.70）、1.12（1.04-1.21）和 1.06（1.01-1.11），与最低值为 80-110mg/dL的患者相比，分别为<20mg/dL、20-40mg/dL、40-60mg/dL 和 60-80mg/dL。随着高血糖和变异性的持续时间增加，死亡的相对风险也随之增加。与最低五分位相比，最高五分位的相对风险为 1.61（1.47-1.78）。高血糖对死亡率的影响与血糖异常的严重程度有关。
死亡率随着血糖偏离正常范围的严重程度和持续时间的增加以及变异性的增加而逐渐增加。这些数据表明，重症监护病房获得性严重高血糖、低血糖和变异性与相似的死亡率风险相关。
