Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Science and Education Södersjukhuset, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
Acta Anaesthesiol Scand. 2021 Oct;65(9):1267-1275. doi: 10.1111/aas.13843. Epub 2021 May 20.
Emerging evidence indicates a relationship between glycemic variability during intensive care unit (ICU) admission and death. We assessed whether mean glucose, hypoglycemia occurrence, or premorbid glycemic control modified this relationship.
In this retrospective, multicenter cohort study, we included adult patients admitted to five ICUs in Australia and Sweden with available preadmission glycated hemoglobin A1c (HbA1c) and three or more glucose readings. We calculated the glycemic lability index (GLI), a measure of glycemic variability, and the time-weighted average blood glucose (TWA-BG) from all glucose readings. We used logistic regression analysis with adjustment for hypoglycemia and admission characteristics to assess the independent association of GLI (above vs. below cohort median) and TWA-BG (above vs. below cohort median) with hospital mortality.
Among 2305 patients, 859 (37%) had diabetes, median GLI was 40 [mmol/L] /h/week, median TWA-BG was 8.2 mmol/L, 171 (7%) developed hypoglycemia, and 371 (16%) died. The adjusted odds ratio for death was 1.61 (95% CI, 1.19-2.15; P = .002) for GLI above versus below median and 1.06 (95% CI, 0.80-1.41; P = .67) for TWA-BG above versus below median. The relationship between GLI and mortality was not modified by TWA-BG (P [interaction] = 0.66), a history of diabetes (P [interaction] = 0.89) or by HbA1c ≥52 mmol/mol (vs. <52 mmol/mol) (P [interaction] = 0.29).
In adult patients admitted to an ICU in Sweden and Australia, a high GLI was associated with increased hospital mortality irrespective of the level of mean glycemia, hypoglycemia occurrence, or premorbid glycemic control. These findings support the assessment of interventions to reduce glycemic variability during critical illness.
新出现的证据表明，重症监护病房（ICU）入院期间的血糖变异性与死亡之间存在关联。我们评估了平均血糖、低血糖发生情况或预患病前血糖控制是否改变了这种关系。
在这项回顾性、多中心队列研究中，我们纳入了来自澳大利亚和瑞典的 5 个 ICU 收治的、有预入院糖化血红蛋白（HbA1c）和 3 次或更多次血糖读数的成年患者。我们计算了血糖变异性指数（GLI），这是一种衡量血糖变异性的指标，以及所有血糖读数的时间加权平均血糖（TWA-BG）。我们使用逻辑回归分析，调整了低血糖和入院特征，以评估 GLI（高于 vs. 低于队列中位数）和 TWA-BG（高于 vs. 低于队列中位数）与住院死亡率的独立相关性。
在 2305 名患者中，859 名（37%）患有糖尿病，中位 GLI 为 40 [mmol/L] /h/week，中位 TWA-BG 为 8.2 mmol/L，171 名（7%）发生低血糖，371 名（16%）死亡。GLI 高于中位数与死亡的调整比值比为 1.61（95%CI，1.19-2.15；P =.002），而 TWA-BG 高于中位数与死亡的比值比为 1.06（95%CI，0.80-1.41；P =.67）。GLI 与死亡率之间的关系不受 TWA-BG（P [交互] =.66）、糖尿病史（P [交互] =.89）或预患病前 HbA1c ≥52 mmol/mol（vs. <52 mmol/mol）（P [交互] =.29）的影响。
在瑞典和澳大利亚 ICU 收治的成年患者中，高 GLI 与住院死亡率增加相关，而与平均血糖水平、低血糖发生情况或预患病前血糖控制无关。这些发现支持评估在危重病期间降低血糖变异性的干预措施。
