Zhou Dawei, Li Zhimin, Shi Guangzhi, Zhou Jianxin
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Medicine (Baltimore). 2020 Aug 14;99(33):e21728. doi: 10.1097/MD.0000000000021728.
The benefit of any specific target range of blood glucose (BG) for post-cardiac arrest (PCA) care remains unknown.We conducted a multicenter retrospective study of prospectively collected data of all cardiac arrest patients admitted to the ICUs between 2014 and 2015. The main exposure was BG metrics during the first 24 hours, including time-weighted mean (TWM) BG, mean BG, admission BG and proportion of time spent in 4 BG ranges (<= 70 mg/dL, 70-140 mg/dL, 140-180 mg/dL and > 180 mg/dL). The primary outcome was hospital mortality. Multivariable logistic regression, Cox proportion hazard models and generalized estimating equation (GEE) models were built to evaluate the association between the different kinds of BG and hospital mortality.2,028 PCA patients from 144 ICUs were included. 14,118 BG measurements during the first 24 hours were extracted. According to TWM-BG, 9 (0%) were classified into the <= 70 mg/dL range, 693 (34%) into the 70 to 140 mg/dL range, 603 (30%) into the 140 to 180 mg/dL range, and 723 (36%) into the > 180 mg/dL range. Compared with BG 70 to 140 mg/dL range, BG 140 to 180 mg/dL range and > 180 mg/dL range were associated with higher hospital mortality probability. Proportion of time spent in the 70 to 140 mg/dL range was associated with good outcome (odds ratio 0.984, CI [0.970, 0.998], P = .022, for per 5% increase in time), and > 180 mg/dL range with poor outcome (odds ratio 1.019, CI [1.009, 1.028], P< .001, for per 5% increase in time). Results of the 3 kinds of statistical models were consistent.The proportion of time spent in BG range 70 to 140 mg/dL is strongly associated with increased hospital survival in PCA patients. Hyperglycemia (> 180 mg/dL) is common in PCA patients and is associated with increased hospital mortality.
心脏骤停后（PCA）护理中，血糖（BG）的任何特定目标范围的益处仍不明确。我们对2014年至2015年期间入住重症监护病房（ICU）的所有心脏骤停患者的前瞻性收集数据进行了多中心回顾性研究。主要暴露因素是最初24小时内的血糖指标，包括时间加权平均（TWM）血糖、平均血糖、入院时血糖以及在4个血糖范围（<=70mg/dL、70 - 140mg/dL、140 - 180mg/dL和>180mg/dL）内所花费时间的比例。主要结局是医院死亡率。构建了多变量逻辑回归、Cox比例风险模型和广义估计方程（GEE）模型，以评估不同类型血糖与医院死亡率之间的关联。纳入了来自144个ICU的2028例PCA患者。提取了最初24小时内的14118次血糖测量值。根据TWM - BG，9例（0%）被归类到<=70mg/dL范围，693例（34%）在70至140mg/dL范围，603例（30%）在140至180mg/dL范围，723例（36%）在>180mg/dL范围。与70至140mg/dL血糖范围相比，140至180mg/dL血糖范围和>180mg/dL血糖范围与更高的医院死亡概率相关。在70至140mg/dL范围所花费时间的比例与良好结局相关（每增加5%时间的优势比为0.984，CI[0.970, 0.998]，P = 0.022），而>180mg/dL范围与不良结局相关（每增加5%时间的优势比为1.019，CI[1.009, 1.028]，P < 0.001）。三种统计模型的结果一致。在PCA患者中，70至140mg/dL血糖范围所花费时间的比例与医院生存率增加密切相关。高血糖（>180mg/dL）在PCA患者中很常见，并且与医院死亡率增加相关。
