Li Lingling, Chen Qinchang, Chen Qingui, Wu Ridong, Wang Shenming, Yao Chen
Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China.
Diabetes Metab Syndr Obes. 2020 Apr 23;13:1305-1315. doi: 10.2147/DMSO.S250133. eCollection 2020.
The aim of this study was to evaluate the association between blood glucose within 24 hours after intensive care unit (ICU) admission and prognosis.
A retrospective cohort study was conducted using data from a large critical care database. Patients who had a length of ICU stay ≥24 hours and at least two blood glucose records within 24 hours after ICU admission were included and hospital mortality was chosen as the primary outcome. The average, minimum, and maximum blood glucose within 24 hours after ICU admission were a priori selected as exposures and associations between each exposure and outcomes were assessed after adjusted for potential confounders.
A total of 14,237 patients were included finally with an average age of 62.9±17.7 years and a mean SAPS II on admission of 34 (26-44). Among the study population, 20.2% (2872/14,237) had uncomplicated diabetes, and 6.7% (953/14,237) had complicated diabetes. Lowest hospital mortality rate was observed in the stratum with an average blood glucose ranged 110-140 mg/dL, a minimum blood glucose ranged 80-110 mg/dL, and a maximum blood glucose ranged 110-140 mg/dL. After adjusted for confounders including age, sex, disease severity scores and comorbidities, an average blood glucose ranged 110-140 mg/dL, a minimum blood glucose ranged 80-110 mg/dL, and a maximum blood glucose ranged 110-140 mg/dL were associated with the lowest risk of hospital mortality. Consistent results were found among patients without diabetes in the subgroup analyses stratified by diabetes.
A range of 110-140 mg/dL for average and maximum blood glucose and a range of 80-110 mg/dL for minimum blood glucose within 24 hours after ICU admission predicted better prognosis especially among patients without diabetes.
本研究旨在评估重症监护病房（ICU）入院后24小时内的血糖水平与预后之间的关联。
利用一个大型重症监护数据库的数据进行回顾性队列研究。纳入ICU住院时间≥24小时且在ICU入院后24小时内至少有两次血糖记录的患者，并将医院死亡率作为主要结局。预先选择ICU入院后24小时内的平均血糖、最低血糖和最高血糖作为暴露因素，并在对潜在混杂因素进行校正后评估各暴露因素与结局之间的关联。
最终纳入14237例患者，平均年龄为62.9±17.7岁，入院时的平均简化急性生理学评分（SAPS II）为34（26-44）。在研究人群中，20.2%（2872/14237）患有非复杂性糖尿病，6.7%（953/14237）患有复杂性糖尿病。在平均血糖范围为110-140mg/dL、最低血糖范围为80-110mg/dL、最高血糖范围为110-140mg/dL的分层中观察到最低的医院死亡率。在校正包括年龄、性别、疾病严重程度评分和合并症等混杂因素后，平均血糖范围为110-140mg/dL、最低血糖范围为80-110mg/dL、最高血糖范围为110-140mg/dL与最低的医院死亡风险相关。在按糖尿病分层的亚组分析中，未患糖尿病的患者中也发现了一致的结果。
ICU入院后24小时内平均血糖和最高血糖范围为110-140mg/dL，最低血糖范围为80-110mg/dL预示着更好的预后，尤其是在未患糖尿病的患者中。
