Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
Intern Emerg Med. 2019 Jun;14(4):539-548. doi: 10.1007/s11739-019-02034-2. Epub 2019 Feb 7.
Either hypoglycemia or hypoalbuminemia alone is an independent condition associated with increased risk of mortality in critical illness. This study evaluates whether the mortality risk increases in septic patients if these conditions are combined. Patients admitted to our hospital from 2008 to 2015 who satisfied the definition of sepsis were targeted (n = 336). We classified cases into three groups based on blood glucose (BG) level measured at admission: hypoglycemia (Hypo-G; BG < 80 mg/dl), intermediate glycemia (Inter-G; 80-199 mg/dl), and hyperglycemia (Hyper-G; ≥ 200 mg/dl) group, and then estimated mortality. We also compared the clinical data of these glycemic groups in combination with hypoalbuminemia (Hypo-A) or Inter-G with non-hypoalbuminemia (Inter-G + Nonhypo-A), as a secondary analysis. Diagnostic cut-off level of Hypo-A (< 2.8 mg/dl) was determined using the ROC curve between blood albumin and mortality. In Hypo-G group (n = 40), APACHE II/SOFA scores are significantly higher than in the Inter-G (n = 196) and Hyper-G groups (n = 100). Mortality is 52.5% in the Hypo-G and 60.0% in the Hypo-G with Hypo-A (Hypo-G + Hypo-A) groups. Significantly higher APACHE II or SOFA scores and mortality are observed in the Hypo-G + Hypo-A group compared to the Inter-G + Nonhypo-A group. A higher mortality risk is observed in cases with Hypo-G + Hypo-A (OR 5.065) than those with Hypo-G (OR 3.503), Inter-G (OR 1.175), Hyper-G (OR 1.756) or Hypo-A (OR 3.243), calculated by a single logistic-regression analysis. Hypo-G + Hypo-A in patients with sepsis is related to higher ICU mortality. Physicians should be keenly aware of these conditions to provide immediate intensive treatment after admission of septic patients.
无论是低血糖还是低白蛋白血症，单独存在都是与危重病患者死亡率增加相关的独立因素。本研究评估了败血症患者如果同时存在这两种情况，其死亡率是否会增加。我们以 2008 年至 2015 年期间我院收治的符合败血症定义的患者为研究对象（n=336）。根据入院时测量的血糖（BG）水平，我们将病例分为三组：低血糖（Hypo-G；BG<80mg/dl）、中血糖（Inter-G；80-199mg/dl）和高血糖（Hyper-G；≥200mg/dl）组，然后估计死亡率。我们还比较了这些血糖组与低白蛋白血症（Hypo-A）或中血糖与非低白蛋白血症（Inter-G+Nonhypo-A）相结合的临床数据，作为次要分析。使用血清白蛋白与死亡率之间的 ROC 曲线确定 Hypo-A 的诊断截断值（<2.8mg/dl）。在 Hypo-G 组（n=40）中，APACHE II/SOFA 评分明显高于 Inter-G 组（n=196）和 Hyper-G 组（n=100）。Hypo-G 组的死亡率为 52.5%，Hypo-G 合并 Hypo-A（Hypo-G+Hypo-A）组的死亡率为 60.0%。与 Inter-G+Nonhypo-A 组相比，Hypo-G+Hypo-A 组的 APACHE II 或 SOFA 评分和死亡率明显更高。与 Hypo-G 组（OR 3.503）、Inter-G 组（OR 1.175）、Hyper-G 组（OR 1.756）或 Hypo-A 组（OR 3.243）相比，Hypo-G+Hypo-A 组的死亡率更高，这是通过单因素逻辑回归分析计算得出的。败血症患者合并 Hypo-G+Hypo-A 与 ICU 死亡率升高相关。医生应密切关注这些情况，以便在败血症患者入院后立即给予强化治疗。
