Abusamaan Mohammed S, Marzinke Mark A, Ashok Aditya, Carroll Karen, Lane Kyrstin, Jeun Rebecca, Moseley Kendall F, Carson Kathryn A, Mathioudakis Nestoras N
Division of Endocrinology, Diabetes, & Metabolism.
Department of Pathology, Johns Hopkins University School of Medicine.
Medicine (Baltimore). 2020 Jan;99(2):e18679. doi: 10.1097/MD.0000000000018679.
This study aimed to correlate hypoglycemic risk exposures (HREs) with low blood glucose value (BGV) in ambulatory patients to inform selection of a glucose critical action value (CAV).This was a retrospective study of ambulatory patients with at least 1 serum glucose ≤70 mg/dL obtained at 2 laboratories within the Johns Hopkins Health System over 3.8 years. Multivariable logistic regression was used to evaluate association of BGV cut-offs of <60, <54, <50, and <45 mg/dL with HREs. HREs were classified as "high hypoglycemic risk" (HHR), "moderate hypoglycemic risk" (MHR), "low hypoglycemic risk" (LHR), and "no hypoglycemic risk" (NHR).A total of 5404 patient samples of BG ≤70 mg/dL were analyzed, of which 30.3%, 23.2%, 28.5%, 18.0% occurred in NHR, LHR, MHR, and HHR groups, respectively. An inverse relationship was noted between BGV cut-offs and HHR, but no association was observed for LHR or MHR. After adjusting for age, sex, and race, there was an inverse association between BG thresholds and the odds of HHR. For classification of HHR, BGV cut-offs of <60, <54, <50, and <45 mg/dL correctly classified 71.2%, 69.8%, 68.8%, and 67.2% of BG samples, achieved false-positive rates of 13.6%, 4.7%, 1.7%, and 0.5% and positive likelihood ratios of 3.3, 6.0, 11.2, and 23.4, respectively.Nearly 70% of low BGVs occurred in patients with at least 1 HRE, but only ∼20% occurred in HHR patients. Given their high positive likelihood ratios, BGVs <54 or <50 mg/dL are reasonable candidates for CAVs that would allow sufficient clinician response time while minimizing false-positive alerts.
本研究旨在将动态监测患者的低血糖风险暴露（HREs）与低血糖值（BGV）相关联，为选择血糖危急值（CAV）提供依据。这是一项对约翰霍普金斯医疗系统内3.8年间在2个实验室检测到至少1次血清葡萄糖≤70mg/dL的动态监测患者的回顾性研究。采用多变量逻辑回归分析评估BGV临界值<60、<54、<50和<45mg/dL与HREs之间的关联。HREs分为“高低血糖风险”（HHR）、“中低血糖风险”（MHR）、“低低血糖风险”（LHR）和“无低血糖风险”（NHR）。共分析了5404份BG≤70mg/dL的患者样本，其中分别有30.3%、23.2%、28.5%、18.0%发生在NHR、LHR、MHR和HHR组。观察到BGV临界值与HHR之间呈负相关，但未观察到与LHR或MHR有关联。在调整年龄、性别和种族后，BG阈值与HHR的比值呈负相关。对于HHR的分类，BGV临界值<60、<54、<50和<45mg/dL分别正确分类了71.2%、69.8%、68.8%和67.2%的BG样本，假阳性率分别为13.6%、4.7%、1.7%和0.5%，阳性似然比分别为3.3、6.0、11.2和23.4。近70%的低BGV发生在至少有1次HRE的患者中，但仅约20%发生在HHR患者中。鉴于其较高的阳性似然比，BGV<54或<50mg/dL是CAV的合理选择，既能让临床医生有足够的反应时间，又能将假阳性警报降至最低。
