Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Int J Environ Res Public Health. 2018 May 15;15(5):992. doi: 10.3390/ijerph15050992.
This study was designed to measure the effect of stress-induced hyperglycemia (SIH) and diabetic hyperglycemia (DH) versus non-diabetic normoglycemia (NDN) on the outcomes of trauma patients in the intensive care unit (ICU).
Diabetes mellitus (DM) was determined based on patient history and/or a hemoglobin A1c (HbA1c) level of ≥6.5% at admission. The patients who had serum glucose levels of ≥200 mg/dL in the absence or presence of DM were assigned into the groups SIH and DH, respectively. Diabetic normoglycemia (DN) and NDN were determined based on serum glucose levels of <200 mg/dL in patients with and without DM, respectively. Patients with burn injury or incomplete data were excluded. Detailed data of trauma patients in the ICU of a Level-I trauma center from 1 January 2009 to 31 December 2016 were retrieved from the database of the Trauma Registry System. These patients were classified into four exclusive groups, including NDN ( = 1745), DN ( = 306), SIH ( = 225) and DH ( = 206). The Pearson chi-square test was used to compare categorical data between groups. Continuous variables were compared using one-way analysis of variance along with the Games⁻Howell post hoc test. To decrease the confounding effect of the differences in sex and age, preexisting comorbidities and injury severity score (ISS) among different groups of patients, 1:1 ratio propensity score-matched cohorts were assigned using the NCSS software. The effect of hyperglycemia on the outcomes of patients with and without DM was assessed with a logistic regression analysis.
Among those selected propensity score-matched patient cohorts, the patients with SIH and DH had a 3.88-fold (95% CI, 2.13⁻7.06; < 0.001) and 1.83-fold (95% CI, 1.00⁻3.34; = 0.048) higher mortality, respectively, than those with NDN. Moreover, the patients in the SIH group (10.0 vs. 7.4 days; = 0.005) and those in the DH group (10.1 vs. 7.4 days; = 0.006) who were admitted to the ICU had a significantly longer length of stay than those in the NDN group. In addition, the SIH group had a 2.13-fold (95% CI, 1.04⁻4.36; = 0.038) higher adjusted odds ratio for mortality than the DH group.
This study revealed significantly worse outcomes in terms of mortality among patients with SIH and DH who were admitted to the ICU after controlling for sex and age, preexisting comorbidities and ISS. In addition, patients who had SIH presented significantly higher adjusted odds for mortality than those DH patients. These results suggest that hyperglycemia is detrimental in patients with or without DM who were admitted to the ICU, and there is a different pathophysiological mechanisms behind the SIH and DH.
本研究旨在测量应激性高血糖（SIH）和糖尿病性高血糖（DH）与非糖尿病性正常血糖（NDN）对 ICU 创伤患者结局的影响。
根据患者病史和/或入院时糖化血红蛋白（HbA1c）水平≥6.5%来确定糖尿病（DM）。入院时血清葡萄糖水平≥200mg/dL 的患者分别归入 SIH 和 DH 组，存在或不存在 DM 时的血清葡萄糖水平≥200mg/dL 的患者分别归入糖尿病正常血糖（DN）和 NDN 组。排除烧伤患者或资料不完整的患者。从 2009 年 1 月 1 日至 2016 年 12 月 31 日，从一级创伤中心的创伤登记系统数据库中检索 ICU 创伤患者的详细数据。这些患者分为四个独立的组，包括 NDN（=1745）、DN（=306）、SIH（=225）和 DH（=206）。使用 Pearson 卡方检验比较组间的分类数据。使用单因素方差分析比较连续变量，并使用 Games⁻Howell 事后检验进行比较。为了降低不同组间患者性别和年龄、既往合并症和损伤严重程度评分（ISS）差异的混杂影响，使用 NCSS 软件按 1:1 比例进行倾向评分匹配队列。使用 logistic 回归分析评估高血糖对有和无 DM 患者结局的影响。
在选择的倾向性评分匹配患者队列中，与 NDN 相比，SIH 和 DH 患者的死亡率分别高出 3.88 倍（95%CI，2.13⁻7.06；<0.001）和 1.83 倍（95%CI，1.00⁻3.34；=0.048）。此外，入住 ICU 的 SIH 组（10.0 天比 7.4 天；=0.005）和 DH 组（10.1 天比 7.4 天；=0.006）患者的住院时间明显长于 NDN 组。此外，与 DH 组相比，SIH 组的死亡率调整优势比（OR）为 2.13（95%CI，1.04⁻4.36；=0.038）。
本研究表明，在控制性别和年龄、既往合并症和 ISS 后，入住 ICU 的 SIH 和 DH 患者的死亡率明显更高。此外，与 DH 患者相比，SIH 患者的死亡率调整 OR 明显更高。这些结果表明，高血糖对 ICU 内有或无 DM 的患者都有害，SIH 和 DH 背后存在不同的病理生理机制。
