Li Xiaofei, Zhang Daofu, Chen Yongxin, Ye Weiwei, Wu Shuang, Lou Lianqing, Zhu Yanshuang
Department of Infectious Diseases, Yiwu Central Hospital, No. 519 Nanmen Street, Yiwu, 322000, Zhejiang, China.
Department of Intensive Care Unit, Liaocheng Daochangfu People's Hospital, Liaocheng, 252000, China.
Diabetol Metab Syndr. 2022 Apr 23;14(1):59. doi: 10.1186/s13098-022-00819-8.
Acute glycemic variability (GV) has been correlated with the severity of sepsis. The aim of the study was to evaluate the potential association between acute GV and mortality risk in patients with sepsis.
Cohort studies comparing the risk of death within 3 months between septic patients with higher versus lower acute GV were retrieved by systematic search of Medline, Embase, Web of Science, Wanfang and CNKI databases. We used a random-effect model to pool the data by incorporating the between-study heterogeneity. Sensitivity analyses were performed to evaluate the stability of the findings.
Ten studies including 4296 patients were available for the meta-analysis. Pooled results showed that septic patients with higher acute GV had significantly increased mortality risk compared to those with lower acute GV, as evidenced by results using different parameters including standard deviation of blood glucose (SDBG, risk ratio [RR]: 1.74, 95% confidence interval [CI] 1.36-2.24, p < 0.001; I = 0%), coefficient of variation of blood glucose (RR: 1.91, 95% CI 1.57-2.31, p < 0.001; I = 0%), mean amplitude of glycemic excursion (RR: 1.81. 95% CI 1.36-2.40, p < 0.001; I = 0%), and glycemic lability index (RR: 2.52, 95% CI 1.72-3.68, p < 0.001; I = 0%). Sensitivity analyses by excluding one study at a time did not significantly affect the results (p all < 0.05).
Higher acute GV may be a predictor of mortality risk in patients with sepsis.
急性血糖变异性（GV）与脓毒症的严重程度相关。本研究旨在评估急性GV与脓毒症患者死亡风险之间的潜在关联。
通过系统检索Medline、Embase、Web of Science、万方和知网数据库，检索比较急性GV较高与较低的脓毒症患者3个月内死亡风险的队列研究。我们使用随机效应模型合并数据，纳入研究间的异质性。进行敏感性分析以评估研究结果的稳定性。
10项研究共4296例患者纳入荟萃分析。汇总结果显示，与急性GV较低的脓毒症患者相比，急性GV较高的患者死亡风险显著增加，使用包括血糖标准差（SDBG，风险比[RR]：1.74，95%置信区间[CI] 1.36 - 2.24，p < 0.001；I = 0%）、血糖变异系数（RR：1.91，95% CI 1.57 - 2.31，p < 0.001；I = 0%）、血糖波动幅度均值（RR：1.81，95% CI 1.36 - 2.40，p < 0.001；I = 0%）和血糖不稳定指数（RR：2.52，95% CI 1.72 - 3.68，p < 0.001；I = 0%）等不同参数的结果均证实了这一点。每次排除一项研究的敏感性分析对结果无显著影响（所有p < 0.05）。
较高的急性GV可能是脓毒症患者死亡风险的一个预测指标。
