Tsakiridou Eirini, Makris Demosthenes, Chatzipantazi Vasiliki, Vlachos Odysseas, Xidopoulos Grigorios, Charalampidou Olympia, Moraitis Georgios, Zakynthinos Epameinondas
Department of Critical Care Medicine, University Hospital of Larissa, University of Thessaly School of Medicine, Biopolis, GR41000 Larisa, Greece.
Department of Critical Care Medicine, General Hospital of Serres, GR62100 Serres, Greece.
Crit Care Res Pract. 2013;2013:279479. doi: 10.1155/2013/279479. Epub 2013 Dec 29.
Objective. To evaluate whether diabetes mellitus (DM) and hemoglobin A1c (HbA1c) are risk factors for ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) in critically ill patients. Methods. Prospective observational study; patients were recruited from the intensive care unit (ICU) of a general district hospital between 2010 and 2012.
ICU hospitalization >72 hours and mechanical ventilation >48 hours. HbA1c was calculated for all participants. DM, HbA1c, and other clinical and laboratory parameters were assessed as risk factors for VAP or BSI in ICU. Results. The overall ICU incidence of VAP and BSI was 26% and 30%, respectively. Enteral feeding OR (95%CI) 6.20 (1.91-20.17; P = 0.002) and blood transfusion 3.33 (1.23-9.02; P = 0.018) were independent risk factors for VAP. BSI in ICU (P = 0.044) and ICU mortality (P = 0.038) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14-5.29; P = 0.022) and stroke on admission2.77 (1.12-6.88; P = 0.029). Sepsis 3.34 (1.47-7.58; P = 0.004) and parenteral feeding 6.29 (1.59-24.83; P = 0.009) were independently associated with ICU mortality. HbA1c ≥ 8.1% presented a significant diagnostic performance in diagnosing repeated BSI in ICU. Conclusion. DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU.
目的。评估糖尿病（DM）和糖化血红蛋白（HbA1c）是否为重症患者发生呼吸机相关性肺炎（VAP）和血流感染（BSI）的危险因素。方法。前瞻性观察性研究；2010年至2012年期间从一家综合地区医院的重症监护病房（ICU）招募患者。
ICU住院时间>72小时且机械通气时间>48小时。计算所有参与者的HbA1c。评估DM、HbA1c以及其他临床和实验室参数作为ICU中VAP或BSI的危险因素。结果。VAP和BSI在ICU的总体发生率分别为26%和30%。肠内喂养的比值比（95%置信区间）为6.20（1.91 - 20.17；P = 0.002），输血的比值比为3.33（1.23 - 9.02；P = 0.018）是VAP的独立危险因素。糖尿病患者发生ICU中的BSI（P = 0.044）和ICU死亡率（P = 0.038）显著增加。ICU中BSI的独立危险因素包括入院时的BSI 2.45（1.14 - 5.29；P = 0.022）和入院时的中风2.77（1.12 - 6.88；P = 0.029）。脓毒症3.34（1.47 - 7.58；P = 0.004）和肠外喂养6.29（1.59 - 24.83；P = 0.009）与ICU死亡率独立相关。HbA1c≥8.1%在诊断ICU中反复发生的BSI方面具有显著的诊断效能。结论。DM和HbA1c与VAP或BSI频率增加无关。HbA1c与ICU中反复发生的BSI事件相关。
