Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, No.1 Minde Road, Nanchang, 330006, Jiangxi Province, China.
Department of Clinical Medicine, The Second Clinical Medical College, Nanchang University, Nanchang, China.
Sci Rep. 2023 Mar 13;13(1):4106. doi: 10.1038/s41598-023-30608-w.
To analyze the predictive value of hyperglycemia on the extrapancreatic infection (EPI) and infected pancreatic necrosis (IPN) of severe patients with acute pancreatitis (AP). We enrolled 234 patients with acute pancreatitis admitted to the intensive care unit (ICU) of the Second Affiliated Hospital of Nanchang University from July 2017 to July 2022 for a retrospective cohort study. We collected maximum blood glucose values three times after admission to the ICU within 120 h (Glu1: 0-24 h, Glu2: 24-48 h, Glu3: 48-120 h), the levels of leucocyte, blood urea nitrogen (BUN), C-reactive protein (CRP), procalcitonin (PCT), and albumin within 24 h after admission to the ICU, and the BISAP and SIRS scores of all patients within 24 h. EPI was taken as the primary outcome indicator and IPN as the secondary outcome indicator. The accuracy of blood glucose values in predicting acute pancreatitis infection was measured by the area under the curve (AUC). A total of 56 patients appeared EPI. Univariate analysis showed that Glu3 was associated with IPN in critically ill patients with AP. Multivariate logistic regression analysis showed that Glu2, Glu3, and SIRS > 48 h were associated with EPI in critically ill patients with AP. The AUCs of Glu2 and Glu3 to predict EPI were 0.805(95%CI: 0.717-0.892) and 0.782(95%CI: 0.685-0.878), respectively, and the cutoff values were 12.60 mmol/L and 14.75 mmol/L, respectively. The AUC of Glu2 combined with Glu3 to predict EPI was 0.812(0.725-0.899). The maximum blood glucose on Day2-5 after admission to the ICU can predict infection in critically ill patients with AP. There are differences in etiology while glucose predicting infection. Patients with hypertriglyceridemia AP need to intervene blood glucose levels more actively and earlier, and control it more strictly.
分析高血糖对重症急性胰腺炎（AP）患者胰外感染（EPI）和感染性胰腺坏死（IPN）的预测价值。我们回顾性分析了 2017 年 7 月至 2022 年 7 月南昌大学第二附属医院重症监护病房（ICU）收治的 234 例急性胰腺炎患者，收集患者入 ICU 后 120 h 内 3 次最大血糖值（Glu1：0-24 h，Glu2：24-48 h，Glu3：48-120 h）、入 ICU 后 24 h 内白细胞、血尿素氮（BUN）、C 反应蛋白（CRP）、降钙素原（PCT）和白蛋白水平以及所有患者入 ICU 后 24 h 的 BISAP 和 SIRS 评分。EPI 作为主要结局指标，IPN 作为次要结局指标。通过曲线下面积（AUC）测量血糖值预测急性胰腺炎感染的准确性。共有 56 例患者出现 EPI。单因素分析显示，Glu3 与 AP 重症患者的 IPN 相关。多因素 logistic 回归分析显示，Glu2、Glu3 和 SIRS>48 h 与 AP 重症患者的 EPI 相关。Glu2 和 Glu3 预测 EPI 的 AUC 分别为 0.805（95%CI：0.717-0.892）和 0.782（95%CI：0.685-0.878），截断值分别为 12.60 mmol/L 和 14.75 mmol/L。Glu2 与 Glu3 联合预测 EPI 的 AUC 为 0.812（95%CI：0.725-0.899）。入 ICU 后第 2-5 天的最大血糖值可预测重症 AP 患者的感染。不同病因的血糖预测感染存在差异。高甘油三酯血症性 AP 患者需要更积极、更早地干预血糖水平，并更严格地控制血糖。
