Chen Po-Chuan, Liao Wen-I, Wang Ying-Chuan, Chang Wei-Chou, Hsu Chin-Wang, Chen Ying-Hsin, Tsai Shih-Hung
From the Department of Emergency Medicine (PCC, WIL, YHC, SHT); Department of Family Medicine (YCW); Department of Radiology, Tri-Service General Hospital, National Defense Medical Center (WCC); and Department of Emergency and Critical Care Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan (CWH).
Medicine (Baltimore). 2015 Aug;94(34):e1456. doi: 10.1097/MD.0000000000001456.
Several studies argue against the association between admission hyperglycemia and adverse outcomes in infected diabetic patients. When investigating the association, it is necessary to consider preexisting hyperglycemia. The objective of this study was to assess whether stress-induced hyperglycemia, determined by the glycemic gap between admission glucose levels and A1c-derived average glucose levels adversely affects outcomes in diabetic patients admitted to hospital with community-acquired pneumonia (CAP).We retrospectively analyzed the glycemic gap and adverse outcomes of diabetic patients hospitalized because of CAP from June 1, 2007 to August 31, 2012 in single medical center in Taiwan.A total of 203 patients admitted with principal diagnosis of CAP and available data of glycemic gap.Patients with glycemic gaps ≥40 mg/dL had greater AUROC values for the development of adverse outcomes compared with acute hyperglycemia and long-term glycemic controls. Patients with an elevated glycemic gap had an odds ratio of 3.84 for the incidence of combined adverse outcomes. Incorporation of the glycemic gap into pneumonia severity index, CURB-65 or SMART-COP scores, increased the discriminative performance of predicting the development of adverse outcomes.Glycemic gaps were associated with adverse outcomes of diabetic CAP patients. The discriminative performance of the calculated glycemic gaps was comparable with those of current clinical scoring systems and may further increase the AUROC of each system.
多项研究对感染性糖尿病患者入院时高血糖与不良结局之间的关联提出质疑。在调查这种关联时，有必要考虑既往存在的高血糖情况。本研究的目的是评估由入院血糖水平与糖化血红蛋白（A1c）衍生的平均血糖水平之间的血糖差值所确定的应激性高血糖是否会对因社区获得性肺炎（CAP）入院的糖尿病患者的结局产生不利影响。我们回顾性分析了2007年6月1日至2012年8月31日在台湾一家医疗中心因CAP住院的糖尿病患者的血糖差值和不良结局。共有203例以CAP为主诊断且有血糖差值可用数据的患者。与急性高血糖和长期血糖控制相比，血糖差值≥40mg/dL的患者发生不良结局的受试者工作特征曲线下面积（AUROC）值更高。血糖差值升高的患者发生联合不良结局的比值比为3.84。将血糖差值纳入肺炎严重程度指数、CURB - 65或SMART - COP评分中，可提高预测不良结局发生的鉴别性能。血糖差值与糖尿病CAP患者的不良结局相关。计算出的血糖差值的鉴别性能与当前临床评分系统相当，并且可能进一步提高每个系统的AUROC。
