Centre for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
Regional Intensive Care Unit, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland.
Crit Care. 2018 Oct 27;22(1):268. doi: 10.1186/s13054-018-2158-y.
Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF).
An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples.
Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest.
In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS.
NCT02010073 . Registered on 12 December 2013.
糖尿病是危重症患者常见的伴发疾病。糖尿病可能会降低急性呼吸窘迫综合征（ARDS）的风险，但之前的研究数据存在矛盾。本研究旨在评估危重症合并急性低氧性呼吸衰竭（AHRF）患者中，既往糖尿病与 ARDS 的相关性。
对一项全球性多中心前瞻性观察研究（LUNG SAFE）进行辅助分析。LUNG SAFE 评估了在 4 周期间内需要机械通气且符合 AHRF 标准的入住 ICU 的所有患者。因心力衰竭完全解释 AHRF 而排除的患者除外。重要的临床特征被纳入逐步选择方法（前向和后向选择结合 0.05 的显著性水平）中，以确定一组与任何时候发生 ARDS、发生 ARDS（定义为从符合 AHRF 标准后 2 天开始发生 ARDS）以及院内死亡率相关的独立变量。此外，进行倾向评分分析以说明伴发和不伴发糖尿病患者之间的基线特征差异，并评估糖尿病与研究关注结局之间的相关性。
在这项研究纳入的 4107 例 AHRF 患者中，3022 例（73.6%的 AHRF 患者）在入院时或 ICU 期间符合 ARDS 标准，或发生 ARDS。913 例患者（AHRF 患者的 22.2%）患有既往合并症糖尿病。多变量分析中，糖尿病与发生 ARDS（OR 0.93（0.78-1.11）；p=0.39）、ARDS 晚期发生（OR 0.79（0.54-1.15）；p=0.22）或 ARDS 患者的院内死亡率（OR 1.15（0.93-1.42）；p=0.19）之间无相关性。在患者的匹配样本中，糖尿病与研究关注结局之间无相关性。
在一项针对 AHRF 患者的大型全球观察性研究中，糖尿病与 ARDS 的发生、ARDS 的发生或 ARDS 的结局之间未发现相关性。
NCT02010073。于 2013 年 12 月 12 日注册。
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