Shih Hung-Sheng, Wang Wei-Sheng, Yang Li-Yu, Chang Shu-Hao, Chen Po-Huang, Jhou Hong-Jie
Department of Biomechatronic Engineering, National Taiwan University, Taipei 10617, Taiwan.
Department of Neurology, Changhua Christian Hospital, Changhua 500, Taiwan.
J Clin Med. 2022 Aug 30;11(17):5116. doi: 10.3390/jcm11175116.
In this study, we aim to elucidate the association between nondiabetic hyperglycemia and the short-term prognosis of critically ill patients with acute ischemic stroke. We extracted data using the Medical Information Mart for Intensive Care IV from 2008 to 2019. The primary outcomes were set as intensive care units (ICU) and in-hospital mortality. We developed a Cox proportional hazards model to determine the nonlinear association between serum glucose levels and primary outcomes. Of the 1086 patients included, 236 patients had hyperglycemia. Patients with hyperglycemia were associated with higher ages, female gender, higher Charlson Comorbidity Index scores, and higher Acute Physiology Score III scores. After propensity score matching, 222 pairs remained. The hyperglycemia group had a significantly higher ICU mortality (17.6% vs. 10.8%; = 0.041). Meanwhile, no significant differences in ICU length of stay (5.2 vs. 5.2; = 0.910), in-hospital mortality (26.6% vs. 18.9%, = 0.054), and hospital length of stay (10.0 vs. 9.1; = 0.404) were observed between the two groups. The Kaplan-Meier curves for ICU and in-hospital survival before matching suggested significant differences; however, after matching, they failed to prove any disparity. Non-diabetic patients with acute ischemic stroke have poor clinical characteristic while encountering hyperglycemic events; therefore, careful monitoring in the acute phase is still required.
在本研究中，我们旨在阐明非糖尿病性高血糖与急性缺血性卒中危重症患者短期预后之间的关联。我们使用重症监护医学信息集市IV从2008年至2019年提取数据。主要结局设定为重症监护病房（ICU）和院内死亡率。我们建立了Cox比例风险模型来确定血清葡萄糖水平与主要结局之间的非线性关联。在纳入的1086例患者中，236例患者患有高血糖。高血糖患者的年龄更大、女性居多、Charlson合并症指数评分更高以及急性生理学评分III更高。倾向评分匹配后，剩余222对。高血糖组的ICU死亡率显著更高（17.6%对10.8%；P = 0.041）。同时，两组之间在ICU住院时间（5.2对5.2；P = 0.910）、院内死亡率（26.6%对18.9%，P = 0.054）和住院时间（10.0对9.1；P = 0.404）方面未观察到显著差异。匹配前ICU和院内生存的Kaplan-Meier曲线显示存在显著差异；然而，匹配后未能证明有任何差异。急性缺血性卒中的非糖尿病患者在发生高血糖事件时临床特征较差；因此，急性期仍需仔细监测。
