From the Department of Anesthesiology.
Division of Trauma Anesthesiology.
Anesth Analg. 2021 Aug 1;133(2):455-461. doi: 10.1213/ANE.0000000000005335.
Hyperglycemia is associated with mortality after trauma; however, few studies have simultaneously investigated the association of depth of shock and acute hyperglycemia. We evaluated lactate, as a surrogate measure for depth of shock, and glucose levels on mortality following severe blunt trauma. We hypothesize that measurements of both lactate and glucose are associated with mortality when considered simultaneously.
This is a retrospective cohort study at a single academic trauma center. Inclusion criteria are age 18-89 years, blunt trauma, injury severity score (ISS) ≥15, and transferred from the scene of injury. All serum blood glucose and lactate values were analyzed within the first 24 hours of admission. Multiple metrics of glucose and lactate were calculated: first glucose (Glucadm) and lactate (Lacadm) at hospital admission, mean 24-hour after hospital admission glucose (Gluc24-hMean) and lactate (Lac24-hMean), maximum 24-hour after hospital admission glucose (Gluc24-hMax) and lactate (Lac24-hMax), and time-weighted 24-hour after hospital admission glucose (Gluc24-hTW) and lactate (Lac24-hTW). Primary outcome was in-hospital mortality. Multivariable logistic regression modeling assessed the odds ratio (OR) of mortality, after adjusting for confounding variables.
A total of 1439 trauma patients were included. When metrics of both glucose and lactate were analyzed, after adjusting for age, ISS, and admission shock index, only lactate remained significantly associated with mortality: Lacadm (OR, 1.28; 95% confidence interval [CI], 1.13-1.44); Lac24-hMean (OR, 1.86; 95% CI, 1.52-2.28); Lac24-hMax (OR, 1.39; 95% CI, 1.23-1.56); and Lac24-hTW (OR, 1.86; 95% CI, 1.53-2.26).
Lactate is associated with mortality in severely injured blunt trauma patients, after adjusting for injury severity, age, and shock index. However, we did not find evidence for an association of glucose with mortality after adjusting for lactate.
创伤后高血糖与死亡率相关；然而，很少有研究同时探讨休克深度和急性高血糖之间的关系。我们评估了乳酸作为休克深度的替代指标，以及严重钝性创伤后血糖水平与死亡率的关系。我们假设同时考虑乳酸和葡萄糖的测量值与死亡率相关。
这是一项在单一学术创伤中心进行的回顾性队列研究。纳入标准为年龄 18-89 岁、钝性创伤、损伤严重程度评分（ISS）≥15 分、并从受伤现场转来。所有血清血糖和乳酸值均在入院后 24 小时内进行分析。计算了葡萄糖和乳酸的多个指标：入院时的首次血糖（Glucadm）和乳酸（Lacadm）、入院后 24 小时的平均血糖（Gluc24-hMean）和乳酸（Lac24-hMean）、入院后 24 小时的最大血糖（Gluc24-hMax）和乳酸（Lac24-hMax）以及入院后 24 小时的加权平均血糖（Gluc24-hTW）和乳酸（Lac24-hTW）。主要结局是院内死亡率。多变量逻辑回归模型评估了调整混杂变量后死亡率的优势比（OR）。
共纳入 1439 例创伤患者。当同时分析葡萄糖和乳酸的指标时，在调整年龄、ISS 和入院休克指数后，只有乳酸与死亡率显著相关：Lacadm（OR，1.28；95%置信区间[CI]，1.13-1.44）；Lac24-hMean（OR，1.86；95% CI，1.52-2.28）；Lac24-hMax（OR，1.39；95% CI，1.23-1.56）；以及 Lac24-hTW（OR，1.86；95% CI，1.53-2.26）。
在调整损伤严重程度、年龄和休克指数后，乳酸与严重钝性创伤患者的死亡率相关。然而，在调整乳酸后，我们没有发现葡萄糖与死亡率之间存在关联的证据。
