糖尿病与脓毒症重症患者90天死亡风险增加无关。
Diabetes Is Not Associated With Increased 90-Day Mortality Risk in Critically Ill Patients With Sepsis.
作者信息
van Vught Lonneke A, Holman Rebecca, de Jonge Evert, de Keizer Nicolette F, van der Poll Tom
机构信息
1Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 2Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 3Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 4NICE foundation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 5Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands. 6Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
出版信息
Crit Care Med. 2017 Oct;45(10):e1026-e1035. doi: 10.1097/CCM.0000000000002590.
OBJECTIVES
To determine the association of pre-existing diabetes, hyperglycemia, and hypoglycemia during the first 24 hours of ICU admissions with 90-day mortality in patients with sepsis admitted to the ICU.
DESIGN
We used mixed effects logistic regression to analyze the association of diabetes, hyperglycemia, and hypoglycemia with 90-day mortality (n = 128,222).
SETTING
All ICUs in the Netherlands between January 2009 and 2014 that participated in the Dutch National Intensive Care Evaluation registry.
PATIENTS
All unplanned ICU admissions in patients with sepsis.
INTERVENTIONS
The association between 90-day mortality and pre-existing diabetes, hyperglycemia, and hypoglycemia, corrected for other factors, was analyzed using a generalized linear mixed effect model.
MEASUREMENTS AND MAIN RESULTS
In a multivariable analysis, diabetes was not associated with increased 90-day mortality. In diabetes patients, only severe hypoglycemia in the absence of hyperglycemia was associated with increased 90-day mortality (odds ratio, 2.95; 95% CI, 1.19-7.32), whereas in patients without pre-existing diabetes, several combinations of abnormal glucose levels were associated with increased 90-day mortality.
CONCLUSIONS
In the current retrospective large database review, diabetes was not associated with adjusted 90-day mortality risk in critically ill patients admitted with sepsis.
目的
确定入住重症监护病房（ICU）的脓毒症患者在入住ICU的最初24小时内预先存在的糖尿病、高血糖和低血糖与90天死亡率之间的关联。
设计
我们使用混合效应逻辑回归分析糖尿病、高血糖和低血糖与90天死亡率之间的关联（n = 128,222）。
设置
2009年1月至2014年期间参与荷兰国家重症监护评估登记处的荷兰所有ICU。
患者
所有脓毒症患者的非计划入住ICU情况。
干预措施
使用广义线性混合效应模型分析90天死亡率与预先存在的糖尿病、高血糖和低血糖之间的关联，并对其他因素进行校正。
测量指标和主要结果
在多变量分析中，糖尿病与90天死亡率增加无关。在糖尿病患者中，仅在无高血糖情况下的严重低血糖与90天死亡率增加相关（比值比，2.95；95%置信区间，1.19 - 7.32），而在无预先存在糖尿病的患者中，几种异常血糖水平组合与90天死亡率增加相关。
结论
在当前的回顾性大型数据库审查中，糖尿病与因脓毒症入院的危重症患者经校正的90天死亡风险无关。
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