Mårtensson Johan, Bailey Michael, Venkatesh Balasubramanian, Pilcher David, Deane Adam, Abdelhamid Yasmine Ali, Crisman Marco, Verma Brij, MacIsaac Christopher, Wigmore Geoffrey, Shehabi Yahya, Suzuki Takafumi, French Craig, Orford Neil, Kakho Nima, Prins Johannes, Ekinci Elif I, Bellomo Rinaldo
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia.
Crit Care Resusc. 2017 Sep;19(3):266-273.
To determine the impact of the intensity of early correction of hyperglycaemia on outcomes in patients with diabetic ketoacidosis (DKA) admitted to the intensive care unit.
We studied adult patients with DKA admitted to 171 ICUs in Australia and New Zealand from 2000 to 2013. We used their blood glucose levels (BGLs) in the first 24 hours after ICU admission to determine whether intensive early correction of hyperglycemia to ≤ 180 mg/dL was independently associated with hypoglycaemia, hypokalaemia, hypo-osmolarity or mortality, compared with partial early correction to > 180 mg/dL as recommended by DKA-specific guidelines.
Among 8553 patients, intensive early correction of BGL was applied to 605 patients (7.1%). A greater proportion of these patients experienced hypoglycaemia (20.2% v 9.1%; P < 0.001) and/or hypo-osmolarity (29.4% v 22.0%; P < 0.001), but not hypokalaemia (16.7% v 15.6%; P = 0.47). Overall, 11 patients (1.8%) in the intensive correction group and 112 patients (1.4%) in the partial correction group died (P = 0.42). However, after adjustment for illness severity, partial early correction of BGL was independently associated with a lower risk of hypoglycaemia (odds ratio [OR], 0.38; 95% CI, 0.30-0.48; P < 0.001), lower risk of hypo-osmolarity (OR, 0.80; 95% CI, 0.65-0.98; P < 0.03) and lower risk of death (OR, 0.44; 95% CI, 0.22-0.86; P = 0.02).
In a large cohort of patients with DKA, partial early correction of BGL according to DKA-specific guidelines, when compared with intensive early correction of BGL, was independently associated with a lower risk of hypoglycaemia, hypo-osmolarity and death.
确定糖尿病酮症酸中毒（DKA）患者入住重症监护病房后早期高血糖纠正强度对预后的影响。
我们研究了2000年至2013年期间入住澳大利亚和新西兰171家重症监护病房的成年DKA患者。我们使用他们入住重症监护病房后最初24小时内的血糖水平（BGLs）来确定，与DKA特定指南推荐的将高血糖部分早期纠正至>180mg/dL相比，将高血糖早期强化纠正至≤180mg/dL是否与低血糖、低钾血症、低渗或死亡率独立相关。
在8553例患者中，605例患者（7.1%）接受了BGL早期强化纠正。这些患者中发生低血糖（20.2%对9.1%；P<0.001）和/或低渗（29.4%对22.0%；P<0.001）的比例更高，但低钾血症发生率无差异（16.7%对15.6%；P = 0.47）。总体而言，强化纠正组有11例患者（1.8%）死亡，部分纠正组有112例患者（1.4%）死亡（P = 0.42）。然而，在对疾病严重程度进行调整后，BGL部分早期纠正与较低的低血糖风险（优势比[OR]，0.38；95%置信区间，下限0.30-上限0.48；P<0.001）、较低的低渗风险（OR，0.80；95%置信区间，下限0.65-上限0.98；P<0.03）和较低的死亡风险（OR，0.44；95%置信区间，下限0.22-上限0.86；P = 0.02）独立相关。
在一大群DKA患者中，与BGL早期强化纠正相比，根据DKA特定指南进行BGL部分早期纠正与较低的低血糖、低渗和死亡风险独立相关。
