Mahmoodpoor Ata, Hamishehkar Hadi, Shadvar Kamran, Beigmohammadi Mohammadtaghi, Iranpour Afshin, Sanaie Sarvin
Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
Indian J Crit Care Med. 2016 Feb;20(2):67-71. doi: 10.4103/0972-5229.175938.
The association between hyperglycemia and mortality is believed to be influenced by the presence of diabetes mellitus (DM). In this study, we evaluated the effect of preexisting hyperglycemia on the association between acute blood glucose management and mortality in critically ill patients. The primary objective of the study was the relationship between HbA1c and mortality in critically ill patients. Secondary objectives of the study were relationship between Intensive Care Unit (ICU) admission blood glucose and glucose control during ICU stay with mortality in critically ill patients.
Five hundred patients admitted to two ICUs were enrolled. Blood sugar and hemoglobin A1c (HbA1c) concentrations on ICU admission were measured. Age, sex, history of DM, comorbidities, Acute Physiology and Chronic Health Evaluation II score, sequential organ failure assessment score, hypoglycemic episodes, drug history, mortality, and development of acute kidney injury and liver failure were noted for all patients.
Without considering the history of diabetes, nonsurvivors had significantly higher HbA1c values compared to survivors (7.25 ± 1.87 vs. 6.05 ± 1.22, respectively, P < 0.001). Blood glucose levels in ICU admission showed a significant correlation with risk of death (P < 0.006, confidence interval [CI]: 1.004-1.02, relative risk [RR]: 1.01). Logistic regression analysis revealed that HbA1c increased the risk of death; with each increase in HbA1c level, the risk of death doubled. However, this relationship was not statistically significant (P: 0.161, CI: 0.933-1.58, RR: 1.2).
Acute hyperglycemia significantly affects mortality in the critically ill patients; this relation is also influenced by chronic hyperglycemia.
高血糖与死亡率之间的关联被认为受糖尿病（DM）的影响。在本研究中，我们评估了预先存在的高血糖对危重症患者急性血糖管理与死亡率之间关联的影响。该研究的主要目的是危重症患者糖化血红蛋白（HbA1c）与死亡率之间的关系。该研究的次要目的是重症监护病房（ICU）入院时血糖及ICU住院期间血糖控制与危重症患者死亡率之间的关系。
纳入了入住两个ICU的500例患者。测量了ICU入院时的血糖和糖化血红蛋白（HbA1c）浓度。记录了所有患者的年龄、性别、糖尿病病史、合并症、急性生理与慢性健康状况评分系统II（APACHE II）评分、序贯器官衰竭评估（SOFA）评分、低血糖发作、用药史、死亡率以及急性肾损伤和肝衰竭的发生情况。
不考虑糖尿病病史时，非幸存者的HbA1c值显著高于幸存者（分别为7.25±1.87和6.05±1.22，P<0.001）。ICU入院时的血糖水平与死亡风险显著相关（P<0.006，置信区间[CI]：1.004 - 1.02，相对风险[RR]：1.01）。逻辑回归分析显示，HbA1c增加死亡风险；HbA1c水平每升高一次，死亡风险加倍。然而，这种关系无统计学意义（P：0.161，CI：0.933 - 1.58，RR：1.2）。
急性高血糖显著影响危重症患者的死亡率；这种关系也受慢性高血糖的影响。
