Ernaga Lorea Ander, Hernández Morhain María Cecilia, Ollero García-Agulló María Dolores, Martínez de Esteban Juan Pablo, Iriarte Beroiz Ana, Gállego Culleré Jaime
Servicio de Endocrinología, Complejo Hospitalario de Navarra, Pamplona, España.
Servicio de Endocrinología, Complejo Hospitalario de Navarra, Pamplona, España.
Med Clin (Barc). 2017 Jul 7;149(1):17-23. doi: 10.1016/j.medcli.2016.12.029. Epub 2017 Feb 21.
Stress hyperglycemia has been associated with a worse prognosis in patients hospitalized in critical care units. The aim of this study is to evaluate the impact of blood glucose and glycosylated hemoglobin (HbA1c) levels on the mortality of patients suffering a acute cerebro-vascular event, and to determine if this relationship depends on the presence of diabetes.
A retrospective analysis of 255 patients admitted to the ER for stroke was performed. Venous plasma glucose levels in the emergency room and HbA1c levels within the first 48hours were analyzed. The presence of diabetes was defined in terms of the patients' medical history, as well as their levels of fasting plasma glucose and HbA1c. Mortality was assessed within the first 30 months after the onset of the acute event.
28.2% of patients had diabetes. Higher mortality was observed in patients who had been admitted with plasma glucose levels≥140mg/dl (hazard ratio [HR]=2.22, 95% CI: 1.18-4.16, P=.013) after adjusting for various factors. This relationship was not confirmed in diabetic patients (HR=2.20, 95% CI: 0.66-7.40, P=.201) and was in non-diabetics (HR=2.55, 95% CI: 1.11-5.85, P=.027). In diabetics, HbA1c≥7% was not associated with poor prognosis (HR=0.68, 95% CI: 0.23-1.98, P=.475), whereas non-diabetics with admission levels of HbA1c falling within the pre-diabetes range (5.7% -6.4%) had a higher mortality (HR=2.62, 95% CI: 1.01-6.79, P=.048).
Admission hyperglycemia is associated with a worse prognosis in patients without diabetes admitted for stroke, but this relationship was not seen in diabetics. In non-diabetic patients, HbA1c levels in the pre-diabetes range is associated with higher mortality.
应激性高血糖与重症监护病房住院患者的预后较差有关。本研究的目的是评估血糖和糖化血红蛋白（HbA1c）水平对急性脑血管事件患者死亡率的影响，并确定这种关系是否取决于糖尿病的存在。
对255例因中风入住急诊室的患者进行回顾性分析。分析了急诊室的静脉血浆葡萄糖水平和最初48小时内的HbA1c水平。根据患者的病史以及空腹血浆葡萄糖和HbA1c水平来定义糖尿病的存在。在急性事件发生后的前30个月内评估死亡率。
28.2%的患者患有糖尿病。在调整各种因素后，血浆葡萄糖水平≥140mg/dl入院的患者死亡率更高（风险比[HR]=2.22，95%可信区间：1.18 - 4.16，P = 0.013）。这种关系在糖尿病患者中未得到证实（HR = 2.20，95%可信区间：0.66 - 7.40，P = 0.201），而在非糖尿病患者中得到证实（HR = 2.55，95%可信区间：1.11 - 5.85，P = 0.027）。在糖尿病患者中，HbA1c≥7%与预后不良无关（HR = 0.68，95%可信区间：0.23 - 1.98，P = 0.475），而入院时HbA1c水平处于糖尿病前期范围（5.7% - 6.4%）的非糖尿病患者死亡率更高（HR = 2.62，95%可信区间：1.01 - 6.79，P = 0.048）。
入院时高血糖与因中风入院的非糖尿病患者预后较差有关，但在糖尿病患者中未观察到这种关系。在非糖尿病患者中，糖尿病前期范围内的HbA1c水平与较高的死亡率有关。
