Wang Wen, Chen Wenwen, Liu Yanmei, Li Ling, Li Sheyu, Tan Jing, Sun Xin
Chinese Evidence-Based Medicine Centre and CREAT Group, West China Hospital, 12530Sichuan University, Chengdu, China.
Department of Endocrinology and Metabolism, West China Hospital, 12530Sichuan University, Chengdu, China.
J Intensive Care Med. 2021 Feb;36(2):182-190. doi: 10.1177/0885066619889322. Epub 2019 Nov 20.
We undertook a systematic review and meta-analysis to investigate the relationship between blood glucose levels and mortality in patients with sepsis.
Medline and EMBASE were searched from inception to April 8, 2018. Cohort studies or case-control studies reported the association between blood glucose and mortality in patients with sepsis were selected. Study characteristics, baseline characteristics, definition of hyperglycemia, and outcomes of interest were extracted. We performed a dose-response meta-analysis to assess the effect of blood glucose level on mortality. We also conducted meta-analysis for patients with or without diabetes separately.
Ten cohort studies involving 26 429 patients were included, of which 5 were prospective studies and 5 retrospective studies. Dose-response analysis showed that the effect of blood glucose on mortality may differ in patients with versus without diabetes. There was a U-shaped relationship for patients with diabetes and a J-shaped relationship for patients without diabetes, with blood glucose at 145 to 155 mg/dL corresponding to lowest mortality both in patients with and without diabetes.
Current evidence suggested U-shaped relationship between blood glucose and mortality in all patients irrespective of their diabetes status. Diabetic patients with blood glucose below 145 mg/dL may have poorer prognosis compared to patients without established diabetes.
我们进行了一项系统评价和荟萃分析，以研究脓毒症患者血糖水平与死亡率之间的关系。
检索了从数据库建立至2018年4月8日的Medline和EMBASE数据库。纳入报告脓毒症患者血糖与死亡率之间关联的队列研究或病例对照研究。提取研究特征、基线特征、高血糖的定义以及感兴趣的结局。我们进行了剂量反应荟萃分析，以评估血糖水平对死亡率的影响。我们还分别对有或无糖尿病的患者进行了荟萃分析。
纳入了10项涉及26429例患者的队列研究，其中5项为前瞻性研究，5项为回顾性研究。剂量反应分析表明，血糖对死亡率的影响在有糖尿病和无糖尿病的患者中可能有所不同。糖尿病患者呈U形关系，无糖尿病患者呈J形关系，血糖在145至155mg/dL时，有糖尿病和无糖尿病患者的死亡率均最低。
目前的证据表明，无论糖尿病状态如何，所有患者的血糖与死亡率之间均呈U形关系。血糖低于145mg/dL的糖尿病患者与无糖尿病患者相比，预后可能更差。
