SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia.
College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
J Diabetes Sci Technol. 2024 Mar;18(2):335-344. doi: 10.1177/19322968221124114. Epub 2022 Sep 12.
Interventional studies investigating blood glucose (BG) management in intensive care units (ICU) have been inconclusive. New insights are needed. We assessed the ability of a new metric, the Glycemic Ratio (GR), to determine the relationship of ICU glucose control relative to preadmission glycemia and mortality.
Retrospective cohort investigation (n = 4790) in an adult medical-surgical ICU included patients with minimum four BGs, hemoglobin (Hgb), and hemoglobin A1c (HbA1c). The GR is the quotient of mean ICU BGs (mBG) and estimated preadmission BG, derived from HbA1c.
Mortality displayed a J-shaped curve with GR (nadir GR 0.9), independent of background glycemia, consistent for HbA1c <6.5% vs >6.5%, and Hgb >10 g/dL vs <10 g/dL and medical versus surgical. An optimal range of GR 0.80 to 0.99 was associated with decreased mortality compared with GR above and below this range. The mBG displayed a linear relationship with mortality at lower HbA1c but diminished for HbA1c >6.5%, and dependent on preadmission glycemia. In adjusted analysis, GR remained associated with mortality (odds ratio = 2.61, 95% confidence interval = 1.48-4.62, = .0012), but mBG did not (1.004, 1.000-1.009, .059). A single value on admission was not independently associated with mortality.
The GR provided new insight into malglycemia that was not apparent using mBG, or an admission value. Mortality was associated with acute change from preadmission glycemia (GR). Further assessment of the impact of GR deviations from the nadir in mortality at GR 0.80 to 0.99, as both relative hypo- and hyperglycemia, and as duration of exposure and intensity, may further define the multifaceted nature of malglycemia.
在重症监护病房（ICU）进行的血糖（BG）管理干预研究尚无定论。需要新的见解。我们评估了一种新指标——血糖比值（GR）的能力，以确定 ICU 血糖控制与入院前血糖和死亡率的关系。
对成人内科-外科 ICU 中的 4790 例患者进行回顾性队列研究，这些患者至少有 4 次 BG、血红蛋白（Hgb）和糖化血红蛋白（HbA1c）检测值。GR 是 ICU 平均 BG（mBG）与 HbA1c 估算的入院前 BG 的商。
死亡率与 GR（最低 GR 为 0.9）呈 J 形曲线相关，与背景血糖无关，适用于 HbA1c<6.5%与>6.5%、Hgb>10 g/dL 与<10 g/dL 以及内科与外科患者。与 GR 在此范围之外相比，GR 为 0.80 至 0.99 的最佳范围与死亡率降低相关。在 HbA1c 较低时，mBG 与死亡率呈线性关系，但对于 HbA1c>6.5%时则减弱，并且依赖于入院前血糖。在调整后的分析中，GR 与死亡率相关（优势比=2.61，95%置信区间=1.48-4.62，=0.0012），但 mBG 不相关（1.004，1.000-1.009，=0.059）。入院时的单个值与死亡率无关。
GR 提供了新的见解，表明使用 mBG 或入院值无法明显看出的血糖异常。死亡率与入院前血糖的急性变化（GR）相关。进一步评估 GR 在 0.80 至 0.99 范围内偏离最低点时的死亡率差异，以及作为相对低血糖和高血糖的程度、持续时间和强度，可能会进一步确定血糖异常的多方面性质。
