Lin Shan, He Wanmei, Zeng Mian
Department of Medical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
J Inflamm Res. 2020 Dec 22;13:1151-1166. doi: 10.2147/JIR.S287510. eCollection 2020.
Association of diabetes and admission glucose on the short-term prognosis in patients with critical illnesses are currently ambiguous. We aimed to determine whether diabetes and admission glucose affects short-term prognosis of critically ill patients.
We performed a retrospective analysis of data on 46,476 critically ill patients from the critical care database. Association of diabetes with 28-day mortality was assessed by inverse probability weighting based on the propensity score. Smoothing splines and threshold effect analysis were applied to explore the relationship between admission glucose and clinical outcomes.
Of the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetes. In the main analysis, the 28-day mortality was reduced by 29% (hazard ratio (HR)=0.71, 95% confidence interval (CI) 0.67-0.76) in patients with diabetes compared to those without diabetes. The E-value of 2.17 indicated robustness to unmeasured confounders. Significant interactions were observed for glucose at ICU admission, admission type, and insulin use (Interaction <0.05). A V-shaped relationship was observed between admission glucose and 28-day mortality in non-diabetic patients, with the lowest 28-day mortality corresponding to a glucose level of 101.75 mg/dl (95% CI 94.64-105.80 mg/dl), and admission hypoglycemia or hyperglycemia should be avoided, especially in patients admitted to the surgical intensive care unit (SICU), cardiac surgery recovery unit (CSRU), and coronary care unit (CCU); for diabetic patients, elevated admission glucose does not appear to be associated with a poor prognosis and perhaps may be beneficial except for CCU and CSRU.
The non-detrimental effect of diabetes on the short-term prognosis of critically ill patients was further confirmed, which would reduce 28-day mortality by approximately 29%. For non-diabetic patients, the admission glucose level corresponding to the lowest 28-day mortality was 101.75 mg/dl (95% CI 94.64-105.80 mg/dl); however, for diabetics, the appropriate admission glucose threshold remains unresolved.
糖尿病与危重症患者入院时血糖水平对短期预后的影响目前尚不明确。我们旨在确定糖尿病和入院时血糖水平是否会影响危重症患者的短期预后。
我们对重症监护数据库中46476例危重症患者的数据进行了回顾性分析。基于倾向评分的逆概率加权法评估糖尿病与28天死亡率之间的关联。应用平滑样条和阈值效应分析来探讨入院时血糖水平与临床结局之间的关系。
在纳入研究的33680例患者中，8701例（25.83%）患有糖尿病。在主要分析中，与非糖尿病患者相比，糖尿病患者的28天死亡率降低了29%（风险比（HR）=0.71，95%置信区间（CI）0.67 - 0.76）。E值为2.17表明对未测量的混杂因素具有稳健性。在ICU入院时的血糖水平、入院类型和胰岛素使用方面观察到显著的相互作用（交互作用<0.05）。在非糖尿病患者中，观察到入院时血糖水平与28天死亡率之间呈V形关系，28天死亡率最低对应的血糖水平为101.75mg/dl（95%CI 94.64 - 105.80mg/dl），应避免入院时低血糖或高血糖，尤其是在入住外科重症监护病房（SICU）、心脏手术恢复病房（CSRU）和冠心病监护病房（CCU）的患者中；对于糖尿病患者，入院时血糖升高似乎与预后不良无关，除了CCU和CSRU外，可能还有益处。
进一步证实了糖尿病对危重症患者短期预后无不利影响，这将使28天死亡率降低约29%。对于非糖尿病患者，28天死亡率最低对应的入院血糖水平为101.75mg/dl（95%CI 94.64 - 105.80mg/dl）；然而，对于糖尿病患者，合适的入院血糖阈值仍未明确。
