COVID-19 感染患者院前血糖水平与结局的相关性：一项回顾性队列研究。
Association Between Prehospital Blood Glucose Levels and Outcomes in Patients With COVID-19 Infection: A Retrospective Cohort Study.
机构信息
Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
School of Epidemiology and Public Health, University of Ottawa, K1G 5Z3 Ottawa, Ontario, Canada.
出版信息
Exp Clin Endocrinol Diabetes. 2023 Jun;131(6):338-344. doi: 10.1055/a-2068-6821. Epub 2023 Apr 4.
BACKGROUND
Hyperglycaemia is associated with worse outcomes in many settings. However, the association between dysglycaemia and adverse outcomes remains debated in COVID-19 patients. This study determined the association of prehospital blood glucose levels with acute medical unit (intensive care unit or high dependency unit) admission and mortality among COVID-19-infected patients.
METHODS
This was a single-centre, retrospective cohort study based on patients cared for by the prehospital medical mobile unit from a Swiss university hospital between March 2020 and April 2021. All adult patients with confirmed or suspected COVID-19 infection during the study period were included. Data were obtained from the prehospital medical files. The main exposure was prehospital blood glucose level. A 7.8 mmol/L cut-off was used to define high blood glucose level. Restricted cubic splines were also used to analyse the exposure as a continuous variable. The primary endpoint was acute medical unit admission; secondary endpoints were 7-day and 30-day mortality. Multivariable logistic regressions were performed to compute odds ratios.
RESULTS
A total of 276 patients were included. The mean prehospital blood glucose level was 8.8 mmol/l, and 123 patients presented high blood glucose levels. The overall acute medical unit admission rate was 31.2%, with no statistically significant difference according to prehospital blood glucose levels. The mortality rate was 13.8% at 7 days and 25% at 30 days. The 30-day mortality rate was higher in patients with high prehospital blood glucose levels, with an adjusted odds ratio of 2.5 (1.3-4.8).
CONCLUSIONS
In patients with acute COVID-19 infection, prehospital blood glucose levels do not seem to be associated with acute medical unit admission. However, there was an increased risk of 30-day mortality in COVID-19 patients who presented high prehospital blood glucose levels.
背景
高血糖与许多情况下的不良结局相关。然而，在 COVID-19 患者中，血糖异常与不良结局之间的关联仍存在争议。本研究旨在确定 COVID-19 感染患者的院前血糖水平与入住急性医疗单位（重症监护病房或高依赖病房）和死亡率之间的关系。
方法
这是一项基于瑞士大学医院院前医疗移动单元护理的单中心、回顾性队列研究。研究期间纳入所有确诊或疑似 COVID-19 感染的成年患者。数据来自院前医疗档案。主要暴露因素为院前血糖水平。采用 7.8mmol/L 作为高血糖水平的截断值。还使用受限立方样条来分析连续变量的暴露情况。主要终点是入住急性医疗单位；次要终点是 7 天和 30 天死亡率。采用多变量逻辑回归计算比值比。
结果
共纳入 276 例患者。院前血糖水平的平均值为 8.8mmol/L，123 例患者存在高血糖水平。总体急性医疗单位入住率为 31.2%，与院前血糖水平无统计学差异。7 天死亡率为 13.8%，30 天死亡率为 25%。院前血糖水平较高的患者 30 天死亡率更高，调整后的比值比为 2.5（1.3-4.8）。
结论
在急性 COVID-19 感染患者中，院前血糖水平似乎与急性医疗单位入住无关。然而，院前血糖水平较高的 COVID-19 患者 30 天死亡率的风险增加。
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