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高血糖和血糖变异性在新冠相关急性呼吸窘迫综合征中的预后作用。

The prognostic role of hyperglycemia and glucose variability in covid-related acute respiratory distress Syndrome.

机构信息

Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

出版信息

Diabetes Res Clin Pract. 2021 May;175:108789. doi: 10.1016/j.diabres.2021.108789. Epub 2021 Apr 1.

Abstract

AIMS

Due to heterogeneity on the prognostic role of glucose values and glucose variability in Novel Coronavirus (COVID) disease, we aimed at assessing the prognostic role for Intensive Care Unit (ICU) death of admission hyperglycaemia, peak glycemia and glucose variability in critically ill COVID patients: METHODS: 83 patients consecutively admitted for COVID-related Acute Respiratory Distress Syndrome (ARDS) from from 1st March to 1st October 2020.

RESULTS

Non survivors were older, with more comorbidities and a more severe disease. Corticosteroids were used in the majority of patients (54/83, 65%) with no difference between survivors and non survivors. Mean blood glucose values, (during the first 24 and 48 h, respectively), were comparable between the two subgroups, as well as SD 24 and CV 24. During the first 48 h, survivors showed significantly lower values of SD 48 (p < 0.001) and CV 48, respectively (p < 0.001) than non survivors.

CONCLUSIONS

in consecutive COVID-related ARDS patients admitted to ICU hyperglycemia (>180 mg/dl) is more common in non survivors who also showed a significantly higher glucose variability in the first 48 h since ICU admission. Our findings point to the clinical significance of in-ICU glucose control in severe COVID patients.

摘要

目的

由于新型冠状病毒(COVID)疾病中血糖值和血糖变异性的预后作用存在异质性,我们旨在评估入院高血糖、峰值血糖和危重症 COVID 患者血糖变异性对重症监护病房(ICU)死亡的预后作用:方法:连续纳入 2020 年 3 月 1 日至 10 月 1 日期间因 COVID 相关急性呼吸窘迫综合征(ARDS)而入院的 83 例患者。

结果

非幸存者年龄更大,合并症更多,疾病更严重。大多数患者(83 例中的 54 例,65%)使用了皮质类固醇,但幸存者和非幸存者之间没有差异。两组患者的平均血糖值(分别在第 24 小时和第 48 小时)在两组之间无差异,SD 24 和 CV 24 也无差异。在第 48 小时,幸存者的 SD 48(p<0.001)和 CV 48(p<0.001)值明显低于非幸存者。

结论

在连续 COVID 相关 ARDS 患者中,非幸存者的 ICU 后高血糖症(>180mg/dl)更为常见,且在 ICU 入院后 48 小时内血糖变异性明显更高。我们的研究结果表明,ICU 内血糖控制对严重 COVID 患者具有重要的临床意义。

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