1 Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio.
2 Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Surg Infect (Larchmt). 2019 May/Jun;20(4):305-310. doi: 10.1089/sur.2018.182. Epub 2019 Feb 4.
Necrotizing soft-tissue infection (NSTI) is a devastating disease associated with high rates of morbidity and mortality. Hyperglycemia is associated with poor wound healing; however, there are no studies evaluating glycemic control outcomes in patients with NSTI. The objective of this study was to examine disease progression and death in patients with NSTI who achieved early glycemic control (EGC) compared with patients that did not. A retrospective chart review of patients with NSTI was conducted between November 2011 and August 2017. Early glycemic control was defined as a daily average blood glucose concentration ≤150 mg/dL for a minimum of two consecutive days from admission to hospital day three. The primary outcome of this study was a composite of ≤3 debridement procedures by hospital day 14 and survival to discharge. Secondary outcomes were the total number of debridement procedures, amputation, hospital length of stay (LOS), intensive care unit (ICU) LOS, number of hypoglycemic events throughout hospitalization, and discharge disposition. One-hundred five patients were included in the analysis. There were 62% male patients, mean age of 55.3 years, mean weight of 106.9 kg, and 57.1% with diabetes mellitus (DM). The 54 (51.4%) patients with EGC were less likely to have DM (29.6% versus 86.3%; p < 0.001), had a lower median admission glucose concentration (120.5 [97-144] versus 198 [153-295.5] mg/dL; p < 0.001), and had lower median daily glucose values during the first 96 hours after admission (p < 0.001). There was no significant difference in the primary outcome (83.3%% versus 84.3%; p > 0.99) or incidence of hypoglycemia (14.8% versus 23.5%; p = 0.32). Patients with EGC were more likely to return home after discharge (44.4% versus 23.5%; p = 0.039). Overall, there was no difference in composite clinical outcomes between patients with EGC and those without, although more patients who achieved EGC were discharged home. Patients with DM were less likely to achieve EGC.
坏死性软组织感染（NSTI）是一种死亡率和发病率都很高的破坏性疾病。高血糖与伤口愈合不良有关；然而，目前还没有研究评估 NSTI 患者的血糖控制结果。本研究的目的是比较早期血糖控制（EGC）与未达到血糖控制目标的 NSTI 患者的疾病进展和死亡情况。
对 2011 年 11 月至 2017 年 8 月间的 NSTI 患者进行了回顾性图表审查。EGC 定义为入院后至少连续两天每日平均血糖浓度≤150mg/dL。本研究的主要终点是住院第 14 天≤3 次清创术和出院时的生存情况。次要终点包括清创术的总次数、截肢、住院时间（LOS）、重症监护病房（ICU） LOS、住院期间低血糖事件的数量和出院去向。
共有 105 例患者纳入分析。其中 62%为男性，平均年龄 55.3 岁，平均体重 106.9kg，57.1%患有糖尿病（DM）。54 例（51.4%）EGC 患者更可能没有 DM（29.6%比 86.3%；p<0.001），入院时的中位血糖浓度更低（120.5[97-144]比 198[153-295.5]mg/dL；p<0.001），入院后前 96 小时内的中位每日血糖值也更低（p<0.001）。主要结局（83.3%比 84.3%；p>0.99）或低血糖发生率（14.8%比 23.5%；p=0.32）均无显著差异。EGC 患者出院后更有可能回家（44.4%比 23.5%；p=0.039）。
总体而言，达到 EGC 的患者与未达到 EGC 的患者在复合临床结局方面没有差异，尽管达到 EGC 的患者出院回家的比例更高。患有糖尿病的患者更不可能达到 EGC。
