Singh Manjitpal, Upreti Vimal, Singh Yashpal, Kannapur Anand S, Nakra Monish, Kotwal Narendra
Department of Medicine, Army Hospital (R&R), Delhi Cantonment, New Delhi, India.
Department of Endocrinology, 151 Base Hospital, Guwahati, Assam, India.
Indian J Endocrinol Metab. 2018 Sep-Oct;22(5):632-635. doi: 10.4103/ijem.IJEM_11_18.
Evidence suggests a role of glycemic variability in intensive care unit (ICU) mortality.
To assess effect of glycemic variability and ICU/in-hospital mortality.
Prospective, observational study.
A 20-bedded medical/surgical ICU in a tertiary care hospital.
Critically ill patients requiring life-support measures admitted to the ICU between November 1, 2015 and December 30, 2016 with hyperglycemia [random blood sugar (RBS) ≥200 mg%] and sequential organ failure assessment (SOFA) scores ≤9. Patients were put on predefined insulin infusion protocol, multiple glucose values were obtained, and mean blood glucose level (MGL) was calculated as their simple arithmetic mean. Standard deviation (SD) of MGL and coefficient of variation (CV) of glucose (derived as a percentage of SD to mean blood glucose) were then calculated for each patient and analyzed for all-cause death during hospitalization period.
A total of 123 patients having a mean age of 65.12 ± 16.27 years, mean SOFA score of 5.76 ± 1.76, and mean HbA1c of 6.22 ± 0.73% were included. MGL was 160.65 ± 24.19 mg/dl, SD 33.32 ± 15.08 mg/dl, and CV 20.74 ± 8.43. Deceased as compared to survivors had higher MGL (163.76 ± 24.85 vs 155.62 ± 22.43 mg/dl, = 0.068) and higher glycemic variability (SD 38.92 ± 14.44 vs 25.06 ± 12.27 mg/dl; < 0.001 and CV 23.69 ± 7.9 vs 15.98 ± 6.87; < 0.001). Interestingly, more patients having higher CV at lower MGL (85.7%) died as compared to those having lower CV at higher MGL (55.6%).
High glycemic variability is associated with increased ICU/in-hospital mortality. Outcome of patients having less glycemic variability even with slight hyperglycemia may be better than those having tight glycemic control but higher glycemic variability. Insulin protocols need to be in place for management of hyperglycemia in critical care setting aiming for adequate glycemic control as well as minimizing glycemic variability.
有证据表明血糖变异性在重症监护病房（ICU）死亡率中起作用。
评估血糖变异性与ICU/院内死亡率的关系。
前瞻性观察性研究。
一家三级护理医院中拥有20张床位的内科/外科ICU。
2015年11月1日至2016年12月30日期间入住ICU且需要生命支持措施的危重症患者，伴有高血糖[随机血糖（RBS）≥200mg%]且序贯器官衰竭评估（SOFA）评分≤9。患者采用预先定义的胰岛素输注方案，获取多个血糖值，并将平均血糖水平（MGL）计算为其简单算术平均值。然后计算每位患者MGL的标准差（SD）和血糖变异系数（CV）（以SD占平均血糖的百分比表示），并分析住院期间的全因死亡情况。
共纳入123例患者，平均年龄65.12±16.27岁，平均SOFA评分为5.76±1.76，平均糖化血红蛋白（HbA1c）为6.22±0.73%。MGL为160.65±24.19mg/dl，SD为33.32±15.08mg/dl，CV为20.74±8.43。与幸存者相比，死亡患者的MGL更高（163.76±24.85 vs 155.62±22.43mg/dl，P=0.068），血糖变异性也更高（SD 38.92±14.44 vs 25.06±12.27mg/dl；P<0.001；CV 23.69±7.9 vs 15.98±6.87；P<0.001）。有趣的是，与MGL较高但CV较低的患者（55.6%）相比，MGL较低但CV较高的患者死亡更多（85.7%）。
高血糖变异性与ICU/院内死亡率增加相关。即使血糖轻度升高但血糖变异性较小的患者，其预后可能优于血糖控制严格但血糖变异性较高的患者。在重症监护环境中，需要制定胰岛素方案来管理高血糖，以实现充分的血糖控制并尽量减少血糖变异性。
