2 型糖尿病与中老年创伤患者长期预后的关系。
Association between type 2 diabetes and long-term outcomes in middle-aged and older trauma patients.
机构信息
From the School of Public Health and Preventive Medicine (S.L.D., B.J.G., C.L.E.), Monash University; Emergency Medicine (S.L.D., C.L.E.), Alfred Health, Melbourne, VIC, Australia; Health Data Research UK (B.J.G.), Swansea University, Swansea, UK; Farr Institute (B.J.G.), Swansea University Medical School, Swansea University, Swansea, UK; Baker Heart and Diabetes Institute (R.E.C., C.L.E.), Melbourne; Menzies Institute for Medical Research (R.E.C.), University of Tasmania, Hobart, Tasmania, Australia; and Rehabilitation, Ageing and Independent Living (RAIL) Research Centre (C.L.E.), Monash University, Melbourne, VIC, Australia.
出版信息
J Trauma Acute Care Surg. 2022 Jan 1;92(1):185-192. doi: 10.1097/TA.0000000000003317.
BACKGROUND
Diabetes is associated with increased hospital complications and mortality following trauma. However, there is limited research on the longer-term recovery of trauma patients with diabetes. The aim of this study was to explore the association between type 2 diabetes (T2D) and in-hospital and 24-month outcomes in major trauma patients.
METHODS
In this cohort study using the Victorian State Trauma Registry, middle-aged and older adults (≥45 years) with major trauma were followed up at 24 months postinjury. Logistic regression (univariable and multivariable) analyses were used to determine the association between diabetes status and 24-month patient-reported outcomes. In-hospital outcomes were compared between groups using χ2 tests.
RESULTS
Of the 11,490 participants who survived to hospital discharge, 8,493 survived to 24 months postinjury and were followed up at that time point: 953 people (11%) with and 7540 (89%) without T2D. People with T2D had a higher in-hospital death rate (19%) compared with people without T2D (16%; p < 0.001). After adjusting for confounders, people with T2D had poorer outcomes 24 months postinjury than people without T2D, with respect to functional recovery (Glasgow Outcome Scale Extended) (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.48-0.69) and return to work/study (AOR, 0.51; 95% CI, 0.37-0.71]). People with T2D experienced higher odds of problems with mobility (AOR, 1.92; 95% CI, 1.60-2.30), self-care (AOR, 1.94; 95% CI, 1.64, 2.29), usual activities (AOR, 1.50; 95% CI, 1.26-1.79), pain and discomfort (AOR, 1.75; 95% CI, 1.49-2.07), anxiety and depression (AOR, 1.45; 95% CI, 1.24, 1.70), and self-reported disability (AOR, 1.51; 95% CI, 1.28-1.79) than people without T2D.
CONCLUSION
Major trauma patients with T2D have a poorer prognosis than patients without T2D, both during their hospital admission and 24 months postinjury. Patients with T2D may need additional health care and support following trauma to reach their recovery potential.
LEVEL OF EVIDENCE
Prognostic, level III.
背景
糖尿病与创伤后住院并发症和死亡率增加有关。然而，关于糖尿病创伤患者的长期康复研究有限。本研究旨在探讨 2 型糖尿病（T2D）与主要创伤患者住院和 24 个月结局之间的关系。
方法
本队列研究使用维多利亚州创伤登记处，对年龄在 45 岁及以上的主要创伤幸存者进行 24 个月的随访。采用单变量和多变量逻辑回归分析来确定糖尿病状态与 24 个月患者报告结局之间的关系。使用 χ2 检验比较组间的住院结局。
结果
在幸存至出院的 11490 名参与者中，有 8493 名幸存者在 24 个月后存活并在该时间点进行了随访：953 人（11%）患有 T2D，7540 人（89%）没有 T2D。患有 T2D 的患者住院死亡率（19%）高于未患有 T2D 的患者（16%；p<0.001）。调整混杂因素后，与无 T2D 患者相比，T2D 患者 24 个月后的康复结局较差，表现在功能恢复（格拉斯哥结局量表扩展）（调整优势比 [AOR]，0.58；95%置信区间 [CI]，0.48-0.69）和重返工作/学习（AOR，0.51；95% CI，0.37-0.71）。患有 T2D 的患者更有可能出现移动（AOR，1.92；95% CI，1.60-2.30）、自我护理（AOR，1.94；95% CI，1.64,2.29）、日常活动（AOR，1.50；95% CI，1.26-1.79）、疼痛和不适（AOR，1.75；95% CI，1.49-2.07）、焦虑和抑郁（AOR，1.45；95% CI，1.24,1.70）和自我报告残疾（AOR，1.51；95% CI，1.28-1.79）的几率更高。
结论
与无 T2D 患者相比，患有 T2D 的主要创伤患者在住院期间和受伤后 24 个月的预后更差。T2D 患者在创伤后可能需要额外的医疗保健和支持，以达到康复潜力。
证据水平
预后，III 级。
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