Department of Nephrology, Shihezi City People's Hospital, Shihezi, China.
Clinical Laboratory, Shihezi City People's Hospital, Shihezi, China.
Ann Palliat Med. 2022 Oct;11(10):3193-3202. doi: 10.21037/apm-22-1049.
The mortality rate is high in patients with acute kidney injury (AKI). Hyperglycemia and hypoglycemia alone can increase the morbidity and mortality of patients with AKI. Up to now, no relevant studies have analyzed the relationship between different blood glucose levels and mortality in AKI patients. Therefore, exploring the relationship between baseline blood glucose level and 30-day mortality in patients with AKI can provide early warning information for disease prognosis and provide reference basis for reasonable level of blood glucose control.
This retrospective cohort study was obtained from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Patients had experienced AKI within 48 hours of admission. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Data on patients' baseline blood glucose level on admission was retrieved, and the outcome indicator was 30-day mortality. A multivariate Cox regression analysis and smoothed curve fitting were used to assess the relationship between the baseline blood glucose level and 30-day mortality. The covariates used for adjustment were those in the patient's baseline data.
A total of 14,449 AKI patients were screened. The overall 30-day mortality rate was 17.6%. Patients with blood glucose levels of 6.36-7.35 mmol/L on admission had the lowest 30-day mortality risk. The multivariate Cox regression model and smoothed curve fitting revealed a U-shaped relationship between the baseline blood glucose level and 30-day mortality after adjusting all the covariables of the baseline data. The inflection point occurred at 5.52 mmol/L. The effect size was 0.773 [hazards ratio (HR) =0.773; 95% confidence interval (CI): 0.614-0.975, P=0.030] on the left side of the inflection point, and 1.077 (HR =1.077; 95% CI: 1.059-1.097, P<0.001) on the right side.
The blood glucose of patients with AKI should be controlled at a reasonable level and should not be lower than 5.52 mmol/L, and the optimal control level needs further study. The limitation of this study is that there are some confounding factors in the retrospective study.
急性肾损伤（AKI）患者的死亡率很高。单独的高血糖和低血糖都会增加 AKI 患者的发病率和死亡率。到目前为止，还没有相关研究分析 AKI 患者不同血糖水平与死亡率之间的关系。因此，探讨 AKI 患者入院时基础血糖水平与 30 天死亡率之间的关系，可以为疾病预后提供预警信息，并为合理的血糖控制水平提供参考依据。
本回顾性队列研究从医疗信息监测网 III （MIMIC-III）数据库中获得。患者在入院 48 小时内经历 AKI。AKI 根据肾脏病：改善全球结局（KDIGO）指南进行诊断。检索患者入院时基础血糖水平的数据，结局指标为 30 天死亡率。采用多变量 Cox 回归分析和平滑曲线拟合来评估基础血糖水平与 30 天死亡率之间的关系。用于调整的协变量是患者基线数据中的变量。
共筛选出 14449 例 AKI 患者。总体 30 天死亡率为 17.6%。入院时血糖水平为 6.36-7.35mmol/L 的患者 30 天死亡率最低。多变量 Cox 回归模型和平滑曲线拟合显示，在调整所有基线数据的协变量后，基础血糖水平与 30 天死亡率之间呈 U 型关系。拐点发生在 5.52mmol/L。效应量为 0.773[风险比（HR）=0.773；95%置信区间（CI）：0.614-0.975，P=0.030]在拐点左侧，1.077（HR=1.077；95%CI：1.059-1.097，P<0.001）在拐点右侧。
AKI 患者的血糖应控制在合理水平，不应低于 5.52mmol/L，最佳控制水平需要进一步研究。本研究的局限性在于回顾性研究中存在一些混杂因素。
