Sunnybrook Research Institute, Toronto, Ontario, Canada.
Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Crit Care. 2019 Jan 28;23(1):28. doi: 10.1186/s13054-019-2328-6.
Hyperglycemia during the acute phase after burn is associated with increased morbidity and mortality. There is little knowledge regarding the effect of pre-existing hyperglycemia in the form of diabetes on the outcomes after severe burns. The objective is to determine the impact of diabetes on clinical outcomes after burns.
Single-center cohort study where adult diabetic (n = 76) and non-diabetic (n = 1186) burn patients admitted between 2006 and 2016 were included. Diabetic patients were stratified into those with well-controlled diabetes (n = 24) and poorly controlled diabetes (n = 33) using a HbA1c of 7% as a cutoff; additionally, diabetics were divided into well-controlled glycemia (n = 47) and poorly controlled glycemia (n = 22) based on daily blood glucose measurements during hospitalization.
On univariate analysis, diabetics had a significantly increased median length of stay per percent total body surface area burn (2.1 vs. 1.6 days; p = 0.0026) and a greater number of overall morbidity (1.39 ± 1.63 vs. 0.8 ± 1.24; p = 0.001). After adjustment for patient characteristics, diabetics were associated with significantly increased total morbidity (RR 1.5; 95% CI 1.1-1.9). At discharge, almost two thirds of diabetics needed an escalation of anti-diabetic medication and a quarter had newly developed insulin dependency. There were no differences in morbidity or mortality in the diabetic subgroups.
Diabetics had a longer hospitalization and increased morbidity, regardless of the quality of their anti-diabetic therapy prior to injury. Additionally, diabetes in burn patients is associated with an increased risk of total morbidity.
烧伤后急性期的高血糖与发病率和死亡率增加有关。关于糖尿病前期高血糖对严重烧伤后结局的影响知之甚少。目的是确定糖尿病对烧伤后临床结局的影响。
这是一项单中心队列研究，纳入了 2006 年至 2016 年间收治的成年糖尿病（n=76）和非糖尿病（n=1186）烧伤患者。糖尿病患者根据 HbA1c 水平（7%作为切点）分为血糖控制良好（n=24）和血糖控制不佳（n=33）两组；此外，根据住院期间的每日血糖测量结果，将糖尿病患者分为血糖控制良好（n=47）和血糖控制不佳（n=22）两组。
单因素分析显示，糖尿病患者每 1%体表面积烧伤的平均住院时间明显延长（2.1 天 vs. 1.6 天；p=0.0026），且总发病率更高（1.39±1.63 比 0.8±1.24；p=0.001）。调整患者特征后，糖尿病与总发病率显著增加相关（RR 1.5；95%CI 1.1-1.9）。出院时，近三分之二的糖尿病患者需要升级降糖药物，四分之一的患者出现新发胰岛素依赖。糖尿病亚组的发病率和死亡率无差异。
无论受伤前糖尿病治疗质量如何，糖尿病患者的住院时间延长，发病率增加。此外，糖尿病与烧伤患者总发病率增加有关。
