Bellaver Priscila, Schneider Larissa, Schaeffer Ariell F, Henrique Lilian Rodrigues, Camargo Joíza Lins, Gerchman Fernando, Leitão Cristiane B, Rech Tatiana H
Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
Heliyon. 2023 Jul 22;9(8):e18554. doi: 10.1016/j.heliyon.2023.e18554. eCollection 2023 Aug.
Diabetes mellitus (DM) is not associated with increased mortality in critically ill patients, a phenomenon known as the "diabetes paradox". However, DM is a risk factor for increased mortality in patients with COVID-19. This study aims to investigate the association of DM and stress-induced hyperglycemia at intensive care unit (ICU) with mortality in this population.
This is a retrospective study. Electronic medical records from patients admitted from March 2020 to September 2020 were reviewed. Primary outcome was mortality. Secondary outcomes were ICU and hospital mortality and stay, and need for mechanical ventilation and renal replacement therapy.
187 patients were included. Overall mortality was 43.2%, higher in patients with DM (55.7% vs. 34%; p = 0.007), even after adjustment for age, hypertension, and disease severity. When patients were separated into groups, named normoglycemia (without DM and glycemia ≤140 mg/dL), stress-induced hyperglycemia (without DM and glycemia >140 mg/dL), and DM (previous diagnosis or HbA1c ≥ 6.5%), the mortality rate was 25.8%, 37.3%, and 55.7%, respectively (p = 0.021). Mortality was higher in patients with higher glycemic variability. No statistical difference related to secondary outcomes was observed.
DM, hyperglycemia, and glycemic variability associated with increased mortality in critically ill patients with severe COVID-19, but did not increase the rates of other clinical outcomes. More than stress-induced hyperglycemia, DM was associated with mortality.
糖尿病（DM）与危重症患者死亡率增加无关，这一现象被称为“糖尿病悖论”。然而，DM是2019冠状病毒病（COVID-19）患者死亡率增加的一个危险因素。本研究旨在调查重症监护病房（ICU）中DM和应激性高血糖与该人群死亡率之间的关联。
这是一项回顾性研究。回顾了2020年3月至2020年9月入院患者的电子病历。主要结局是死亡率。次要结局是ICU和医院死亡率及住院时间，以及机械通气和肾脏替代治疗的需求。
纳入187例患者。总体死亡率为43.2%，DM患者的死亡率更高（55.7%对34%；p = 0.007），即使在调整年龄、高血压和疾病严重程度后也是如此。当将患者分为正常血糖组（无DM且血糖≤140 mg/dL）、应激性高血糖组（无DM且血糖>140 mg/dL）和DM组（既往诊断或糖化血红蛋白≥6.5%）时，死亡率分别为25.8%、37.3%和55.7%（p = 0.021）。血糖变异性较高的患者死亡率更高。未观察到与次要结局相关的统计学差异。
在重症COVID-19患者中，DM、高血糖和血糖变异性与死亡率增加相关，但未增加其他临床结局的发生率。与应激性高血糖相比，DM与死亡率的关联更大。
