Department of Pharmacy, UF Health Jacksonville, Jacksonville, Florida, USA.
Department of Biostatistics, UF Health Shands Hospital, Gainesville, Florida, USA.
J Investig Med. 2022 Aug;70(6):1387-1391. doi: 10.1136/jim-2021-002229. Epub 2022 May 17.
Dysglycemia is a common complication in hospitalized patients and has been suggested to play a significant role in the pathology and virulence of patients with bacteremia. The literature evaluating this relationship in critically ill patients, however, is limited. This retrospective, single-center cohort study aimed to investigate the relationship of glycemic control with 28-day intensive care unit (ICU)-free days in critically ill patients with bacteremia. Glycemic control was evaluated and determined based on time in targeted blood glucose range (TIR) of 70-140 mg/dL. Using a threshold of 80%, patients were then categorized into 2 groups: TIR-lo (<80%) and TIR-hi (≥80%). Unadjusted data identified a significant difference in ICU-free days (TIR-lo 21.29 days vs TIR-hi 24.08 days, p=0.007). However, due to an excess of zero ICU-free days, a zero-inflated Poisson model was used for analysis and demonstrated that patients in the TIR-lo group were 2.57 times more likely to have zero ICU-free days (p=0.033), which was attributed to mortality. Of the survivors, no difference was seen with TIR status and the number of ICU-free days (p=0.780). These findings demonstrate that glycemic control may increase the likelihood of being liberated from the ICU within a 28-day period, which the authors attributed to increased survival. However, of the patients who left the ICU, glycemic control was not associated with a significant difference in the number of ICU-free days.
血糖异常是住院患者的常见并发症，并且有人提出它在菌血症患者的病理和毒力中起重要作用。然而，评估这种关系在危重病患者中的文献有限。这项回顾性、单中心队列研究旨在调查血糖控制与菌血症危重病患者 28 天 ICU 无天数的关系。血糖控制通过目标血糖范围内的时间（TIR）评估和确定，范围为 70-140mg/dL。使用 80%的阈值，患者分为 2 组：TIR 低（<80%）和 TIR 高（≥80%）。未调整的数据表明 ICU 无天数有显著差异（TIR 低 21.29 天与 TIR 高 24.08 天，p=0.007）。然而，由于 ICU 无天数的零过多，使用零膨胀泊松模型进行分析，结果表明 TIR 低组患者 ICU 无天数为零的可能性高 2.57 倍（p=0.033），这归因于死亡率。对于幸存者，TIR 状态与 ICU 无天数之间没有差异（p=0.780）。这些发现表明血糖控制可能增加在 28 天内从 ICU 中解放出来的可能性，作者将其归因于存活率的提高。然而，离开 ICU 的患者中，血糖控制与 ICU 无天数的差异无统计学意义。
