Carrasco-Sánchez F J, Carretero-Gómez J, Gómez-Huelgas R, Garcia-Ordoñez M A, Pardo-Ortega M V, de Escalante-Yanguela B, Mateos-Polo L, Formiga F, Ena J
Servicio de Medicina Interna, Hospital Juan Ramón Jiménez, Huelva, España.
Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, España.
Rev Clin Esp (Barc). 2018 Jun-Jul;218(5):223-231. doi: 10.1016/j.rce.2018.02.017. Epub 2018 Apr 13.
Hospital complications and hyperglycemia are common in elderly patients during hospitalization. Our aim was to analyze the relationship between hyperglycemia and hospital complications in an ageing population.
We conducted an observational study to evaluate the association between maximum blood glucose (MBG) levels and hospital complications. Patients were stratified according to the quartiles of MBG levels. Diabetes mellitus (DM) was determined by patient history and/or admission glycated hemoglobin (HbA1c) level ≥6.5%. Hyperglycemia in patients without DM was defined as stress-induced hyperglycemia (SH). The composite primary end-point included frequent complications and/or all-cause hospital mortality.
Among 461 patients, mean age 80±7.5years, 238 (51.6%) patients had DM, 20 had undiagnosed DM, and 162 (35.1%) developed hospital complications. Patients with complications had higher mean daily BG levels (215±84 vs 195±85mg/dl, P<.01). The incidence of complications was directly associated with severity of hyperglycemia according to the quartiles of MBG levels in patients without DM, namely SH (<140 mg/dl, 22.2%; 140-185mg/dl, 40%; 186-250mg/dl, 47%; >250mg/dl, 60%; P=.002), but not in patients with DM (<140mg/dl, 26.3%; 140-185mg/dl, 40.4%; 186-250mg/dl, 35.6%; >250mg/dl, 37.4%; P=.748). In the multivariate analyses, SH was independently associated with complications: OR 2.60 (CI95%: 1.2-5.6), 2.82 (CI95%: 1.2-6.5), 5.50 (CI95%: 1.4-20.8) for the second, third and fourth quartile respectively (P=.01), as compared to the first quartile. We found no association with readmissions and all-cause mortality.
SH in elderly patients is associated with hospital complications, but not with all-cause mortality, compared to patients with diabetes or normoglycemia.
住院期间，老年患者医院并发症和高血糖较为常见。我们的目的是分析老年人群中高血糖与医院并发症之间的关系。
我们开展了一项观察性研究，以评估最高血糖（MBG）水平与医院并发症之间的关联。患者根据MBG水平四分位数进行分层。糖尿病（DM）通过患者病史和/或入院糖化血红蛋白（HbA1c）水平≥6.5%来确定。无DM患者的高血糖定义为应激性高血糖（SH）。复合主要终点包括频繁并发症和/或全因住院死亡率。
在461例患者中，平均年龄80±7.5岁，238例（51.6%）患有DM，20例DM未确诊，162例（35.1%）出现医院并发症。有并发症的患者平均每日血糖水平更高（215±84 vs 195±85mg/dl，P<0.01）。根据无DM患者（即SH）MBG水平四分位数，并发症发生率与高血糖严重程度直接相关（<140mg/dl，22.2%；140 - 185mg/dl，40%；186 - 250mg/dl，47%；>250mg/dl，60%；P = 0.002），但DM患者中并非如此（<140mg/dl，26.3%；140 - 185mg/dl，40.4%；186 - 250mg/dl，35.6%；>250mg/dl，37.4%；P = 0.748）。在多变量分析中，SH与并发症独立相关：与第一四分位数相比时，第二、第三和第四四分位数的OR分别为2.60（CI95%：1.2 - 5.6）、2.82（CI95%：1.2 - 6.5）、5.50（CI95%：1.4 - 20.8）（P = 0.01）。我们未发现与再入院和全因死亡率有关联。
与糖尿病患者或血糖正常患者相比，老年患者中的SH与医院并发症相关，但与全因死亡率无关。
