Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353 Berlin, Germany.
Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, D-10178 Berlin, Germany.
J Crit Care. 2021 Jun;63:32-39. doi: 10.1016/j.jcrc.2021.01.012. Epub 2021 Jan 29.
Critical Illness Myopathy (CIM) is a serious ICU complication, and dysglycaemia is widely regarded as a risk factor. Although glucose variability (GV) has been independently linked to ICU mortality, an association with CIM has not been investigated. This study examines the relationship between CIM and GV.
Retrospective investigation including ICU patients with SOFA ≥8, mechanical ventilation, and CIM diagnostics. Glucose readings were collected every 6 h throughout the first week of treatment, when CIM is thought to develop. GV was measured using standard deviation (SD), coefficient of variability (CV), mean absolute glucose (MAG), mean amplitude of glycaemic excursions (MAGE), and mean of daily difference (MODD).
74 patients were included, and 50 (67.6%) developed CIM. Time on glycaemic target (70-179 mg/dL), caloric and insulin intakes, mean, maximum and minimum blood glucose values were similar for all patients until the 5th day, after which CIM patients exhibited higher mean and maximum glucose levels. Significantly higher GV in CIM patients were observed on day 5 (SD, CV, MAG, MAGE), day 6 (MODD), and day 7 (SD, CV, MAG).
CIM patients developed transient increases in GV and hyperglycaemia only late in the first week, suggesting that myopathy precedes dysglycaemia.
危重病性肌病（CIM）是一种严重的 ICU 并发症，而血糖异常被广泛认为是危险因素。尽管血糖变异性（GV）已被独立与 ICU 死亡率相关联，但与 CIM 的关联尚未被研究。本研究探讨了 CIM 与 GV 之间的关系。
回顾性研究纳入了 SOFA ≥8、机械通气和 CIM 诊断的 ICU 患者。在治疗的第一周内，每 6 小时收集一次血糖读数，此时被认为会发生 CIM。使用标准差（SD）、变异系数（CV）、平均绝对血糖（MAG）、血糖波动幅度（MAGE）和平均每日差值（MODD）来衡量 GV。
共纳入 74 例患者，其中 50 例（67.6%）发生了 CIM。所有患者的血糖目标（70-179mg/dL）、热量和胰岛素摄入、平均值、最大值和最小值在第 5 天之前均相似，此后 CIM 患者的平均和最大血糖水平更高。CIM 患者在第 5 天（SD、CV、MAG、MAGE）、第 6 天（MODD）和第 7 天（SD、CV、MAG）的 GV 显著更高。
CIM 患者仅在第一周后期才出现 GV 和高血糖的短暂增加，表明肌病先于血糖异常。
