Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
Surgery. 2019 Aug;166(2):184-192. doi: 10.1016/j.surg.2019.02.022. Epub 2019 Apr 9.
Glucose variability is common among hospitalized patients, but the prognostic implications among patients hospitalized in surgical wards are unknown. The objective of this study was to investigate the association between glucose variability, length of stay, and mortality.
Historical prospectively collected data of patients ≥18 years of age, hospitalized in general surgery wards between January 2011 and December 2017. Glucose variability was assessed by coefficient of variance and standard deviation of glucose values during hospitalization. The main outcomes were length of stay and 30-day and end-of-follow-up mortality.
The cohort included 8,894 patients (mean age 63 ± 19 years, 48% male, mean follow-up 3.0 ± 1.8 years). A total of 2,012 (23%) patients had diabetes mellitus. The mean length of stay was longer with a higher coefficient of variance or standard deviation in patients without and with diabetes mellitus. The 30-day mortality was 6%, associated with a higher versus a lower coefficient of variance (9% vs 3%) and standard deviation (9% vs 3%) in patients without diabetes mellitus and with diabetes mellitus (9% vs 5%; 8% vs 5%, respectively). Mortality at the end of follow-up was increased in patients without diabetes mellitus with a higher coefficient of variance (27% vs 18%) and standard deviation (29% vs 17%) and in patients with diabetes mellitus (33% vs 24% and 32% vs 21%, respectively). Multivariate analysis indicated an increased risk for 30-day and end-of-follow-up mortality, in both groups. Adjustment for glucocorticoid treatment or hypoglycemia did not affect the results. In patients with a high or low coefficient of variance, mortality was higher with median glucose levels during hospitalization ≥180 mg/dl, compared with <180 mg/dl.
In patients with and without diabetes mellitus hospitalized in general surgery wards, increased glucose variability is associated with longer hospitalization and increased short-term and long-term mortality.
住院患者中葡萄糖变异性很常见，但外科病房住院患者的预后意义尚不清楚。本研究旨在探讨葡萄糖变异性与住院时间和死亡率之间的关系。
回顾性收集 2011 年 1 月至 2017 年 12 月期间在普通外科病房住院的年龄≥18 岁患者的历史数据。住院期间通过葡萄糖值的变异系数和标准差评估葡萄糖变异性。主要结局为住院时间和 30 天及随访结束时的死亡率。
该队列包括 8894 名患者（平均年龄 63 ± 19 岁，48%为男性，平均随访 3.0 ± 1.8 年）。共有 2012 名（23%）患者患有糖尿病。无糖尿病和有糖尿病的患者，变异系数或标准差越高，住院时间越长。30 天死亡率为 6%，无糖尿病和有糖尿病的患者，变异系数较高（9%比 3%）和标准差较高（9%比 3%），与变异系数较低（3%比 9%）和标准差较低（3%比 9%）相比，死亡率更高（9%比 3%和 8%比 5%）。无糖尿病的患者中，变异系数较高（27%比 18%）和标准差较高（29%比 17%）的患者，以及有糖尿病的患者（33%比 24%和 32%比 21%），随访结束时的死亡率增加。多变量分析表明，两组患者 30 天和随访结束时的死亡风险均增加。调整糖皮质激素治疗或低血糖症并不影响结果。在变异系数高或低的患者中，与住院期间中位血糖水平<180mg/dl 相比，住院期间中位血糖水平≥180mg/dl 时死亡率更高。
在普通外科病房住院的有糖尿病和无糖尿病的患者中，葡萄糖变异性增加与住院时间延长以及短期和长期死亡率增加相关。
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