Zhang Luming, Wang Zichen, Xu Fengshuo, Han Didi, Li Shaojin, Yin Haiyan, Lyu Jun
Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Front Cardiovasc Med. 2021 May 19;8:683932. doi: 10.3389/fcvm.2021.683932. eCollection 2021.
Diabetes mellitus (DM) has a high morbidity and mortality worldwide, and it is a risk factor for cardiovascular diseases. Non-diabetic stress hyperglycemia is common in severely ill patients, and it could affect prognosis. This study aimed to analyze the influence of different blood glucose levels on prognosis from the perspective of stress hyperglycemia by comparing them with normal blood glucose levels and those of patients with DM. A retrospective study of 1,401 patients in coronary care unit (CCU) from the critical care database called Medical Information Mart for Intensive Care IV was performed. Patients were assigned to the following groups 1-4 based on their history of DM, random blood glucose, and HbA1c levels: normal blood glucose group, moderate stress hyperglycemia group, severe stress hyperglycemia group and DM group. The main outcome of this study was 30- and 90-day mortality rates. The associations between groups and outcomes were analyzed using Kaplan-Meier survival analysis, Cox proportional hazard regression model and competing risk regression model. A total of 1,401 patients in CCU were enrolled in this study. The Kaplan-Meier survival curve showed that group 1 had a higher survival probability than groups 3 and 4 in terms of 30- and 90-day mortalities. After controlling the potential confounders in Cox regression, groups 3 and 4 had a statistically significant higher risk of both mortalities than group 1, while no difference in mortality risk was found between groups 2 and 1. The hazard ratios [95% confidence interval (CI)] of 30- and 90-day mortality rates for group 3 were 2.77(1.39,5.54) and 2.59(1.31,5.12), respectively, while those for group 4 were 1.92(1.08,3.40) and 1.94(1.11,3.37), respectively. Severe stress hyperglycemia (≥200 mg/dL) in patients without DM in CCU may increase the risk of short-term death, which is greater than the prognostic effect in patients with diabetes. Patients with normal blood glucose levels and moderate stress hyperglycemia (140 mg/dL ≤ RBG <200 mg/dL) had no effect on short-term outcomes in patients with CCU.
糖尿病（DM）在全球范围内具有较高的发病率和死亡率，并且是心血管疾病的一个危险因素。非糖尿病应激性高血糖在重症患者中很常见，且会影响预后。本研究旨在通过将不同血糖水平与正常血糖水平及糖尿病患者的血糖水平进行比较，从应激性高血糖的角度分析其对预后的影响。对重症监护数据库“医学重症监护信息集市IV”中冠心病监护病房（CCU）的1401例患者进行了一项回顾性研究。根据患者的糖尿病病史、随机血糖和糖化血红蛋白水平，将患者分为以下1 - 4组：正常血糖组、中度应激性高血糖组、重度应激性高血糖组和糖尿病组。本研究的主要结局是30天和90天死亡率。使用Kaplan - Meier生存分析、Cox比例风险回归模型和竞争风险回归模型分析组间与结局之间的关联。CCU共有1401例患者纳入本研究。Kaplan - Meier生存曲线显示，就30天和90天死亡率而言，第1组的生存概率高于第3组和第4组。在Cox回归中控制潜在混杂因素后，第3组和第4组的两种死亡率风险在统计学上均显著高于第1组，而第2组和第1组之间未发现死亡率风险差异。第3组30天和90天死亡率的风险比[95%置信区间（CI）]分别为2.77（1.39，5.54）和2.59（1.31，5.12），而第4组分别为1.92（1.08，3.40）和1.94（1.11，3.37）。CCU中无糖尿病患者的重度应激性高血糖（≥200 mg/dL）可能会增加短期死亡风险，且该风险大于糖尿病患者的预后影响。正常血糖水平和中度应激性高血糖（140 mg/dL≤随机血糖＜200 mg/dL）的患者对CCU患者的短期结局无影响。
