Dendy Jared A, Chockalingam Vijayaratna, Tirumalasetty Naga N, Dornelles Adriana, Blonde Lawrence, Bolton Peggy M, Meadows Renee Y, Andrews Samuel S
Department of Internal Medicine, Ochsner Medical Center, New Orleans, Louisiana.
Department of Endocrinology, Ochsner Medical Center, New Orleans, Louisiana.
Endocr Pract. 2014 Oct;20(10):1051-6. doi: 10.4158/EP13467.OR.
Some of the deleterious effects of hypoglycemia in hospitalized patients include increased rates of mortality and longer length of stay. Our primary objective was to identify the risk factors associated with severe hypoglycemia to identify those patients at highest risk.
The medical records of 5,026 patients with diabetes mellitus (DM) admitted in 2010 were reviewed to identify those patients that developed severe hypoglycemia (blood glucose [BG] <40 mg/dL). We performed χ2 tests to assess statistical significance. Adjusted logical regression was used to determine the risk factors for hypoglycemia in the hospital.
Out of 5,026 DM patients included in our review, 81 experienced severe hypoglycemia (1.6%). Statistically higher proportions of chronic kidney disease (CKD; 69.1% vs. 46.9%, P<.001), congestive heart failure (CHF; 48.1% vs. 28.5%, P<.001), sepsis (49.4% vs. 12.5%, P<.001), insulin use (45.7% vs. 26.04%, P = .000), type 1 DM (21% vs. 5.1%, P = .000), and cirrhosis (14.8% vs. 7.2%, P = .009) were seen in the severe hypoglycemic group compared to the nonsevere hypoglycemic group. Overall, 84% of patients who experienced an episode of severe hypoglycemia in the hospital (BG <40 mg/dL) had a previous episode of hypoglycemia (BG <70 mg/dL). The odds ratios (ORs) for type 1 DM, sepsis, previous hypoglycemia, and insulin use were 3.43 (95% confidence interval [CI] 1.81, 6.49), 2.64 (95% CI 1.6, 4.35), 46.1 (95% CI 24.76, 85.74), and 1.66 (95% CI 1.02, 2.69), respectively.
Prior episodes of hypoglycemia in the hospital, the presence of type 1 DM, insulin use, and sepsis were identified as independent risk factors for the development of severe hypoglycemia in the hospital.
低血糖对住院患者的一些有害影响包括死亡率增加和住院时间延长。我们的主要目标是确定与严重低血糖相关的风险因素，以识别出风险最高的患者。
回顾了2010年收治的5026例糖尿病（DM）患者的病历，以确定发生严重低血糖（血糖[BG]<40mg/dL）的患者。我们进行了χ2检验以评估统计学意义。采用校正逻辑回归分析来确定医院内低血糖的风险因素。
在我们回顾的5026例DM患者中，81例发生了严重低血糖（1.6%）。与非严重低血糖组相比，严重低血糖组中慢性肾脏病（CKD；69.1%对46.9%，P<0.001）、充血性心力衰竭（CHF；48.1%对28.5%，P<0.001）、脓毒症（49.4%对12.5%，P<0.001）、使用胰岛素（45.7%对26.04%，P = 0.000）、1型DM（21%对5.1%，P = 0.000）和肝硬化（14.8%对7.2%，P = 0.009）的比例在统计学上更高。总体而言，在医院发生严重低血糖发作（BG<40mg/dL）的患者中，84%曾有过低血糖发作（BG<70mg/dL）。1型DM、脓毒症、既往低血糖和胰岛素使用的比值比（OR）分别为3.43（95%置信区间[CI]1.81，6.49）、2.64（95%CI 1.6，4.35）、46.1（95%CI 24.76，85.74）和1.66（95%CI 1.02，2.69）。
医院内既往低血糖发作、1型DM的存在、胰岛素使用和脓毒症被确定为医院内发生严重低血糖的独立风险因素。
