住院患者血糖变异性与新冠病毒疾病死亡率之间的关联：一项前瞻性研究。
Association between inpatient glycemic variability and COVID-19 mortality: a prospective study.
作者信息
Ali El Chab Parolin Salma, Benicio Stocco Rebecca, Kneipp Lopes Julia do Carmo, Curcio Pereira Marcos Roberto, Massae Yamashita Milena, Domareski Goulart Maria Eduarda, Demeneck Henrique, Olandoski Marcia, Hermann de Souza Nunes Larissa, Keniche Morisawa Victor, Fanhani Cracco Luiz Augusto, Busto Silva Isabela, Silva Motta Júnior Jarbas, Veit Barreto Daniela, Lenci Marques Gustavo, Proença de Moraes Thyago, Pellegrino Baena Cristina
机构信息
Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil.
出版信息
Diabetol Metab Syndr. 2023 Sep 11;15(1):185. doi: 10.1186/s13098-023-01157-z.
BACKGROUND
This study aimed to determine the association between glycemic variability (GV) and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19).
METHODS
We prospectively analyzed data from inpatients (> 18 years old) with RT-PCR confirmed COVID-19 admitted between March 2020 and July 2021. All patients were hospitalized for more than 48 h and had at least six point-of-care capillary glucose tests obtained three times daily in the pre-prandial period during hospitalization. GV was measured using the glucose standard deviation (SD) and coefficient of variation (CV). ROC curve was adjusted to determine the SD and CV cutoff values associated with mortality (44.7 mg/dL and 27.5%, respectively); values above these were considered indicative of high GV. Logistic regression models were fitted to explore the association between GV and mortality in patients with and without diabetes.
RESULTS
A total of 628 patients were stratified into SD < 44.7 mg/dL (n = 357) versus ≥ 44.7 mg/dL (n = 271) and CV < 27.5% (n = 318) versus ≥ 27.5% (n = 310) groups. After controlling for age, sex, presence of diabetes mellitus (DM) and cardiovascular disease, we found a significant association between high GV and mortality (odds ratio 2.99 [1.88-4.77] for SD and 2.43 [1.54-3.85] for CV; p values < 0.001). The mortality rate was higher with SD ≥ 44.7 mg/dL and CV ≥ 27.5% compared to that with SD < 44.7 mg/dL and CV < 27.5%, regardless of DM (p < 0.001 for all).
CONCLUSION
High glycemic variability was independently associated with mortality in patients with and without DM, who were hospitalized with COVID-19.
背景
本研究旨在确定2019冠状病毒病（COVID-19）住院患者的血糖变异性（GV）与死亡率之间的关联。
方法
我们前瞻性分析了2020年3月至2021年7月期间因RT-PCR确诊为COVID-19的住院患者（年龄>18岁）的数据。所有患者住院时间超过48小时，且在住院期间的餐前阶段每天至少进行三次、每次至少六点的即时毛细血管血糖检测。使用血糖标准差（SD）和变异系数（CV）来测量GV。调整ROC曲线以确定与死亡率相关的SD和CV临界值（分别为44.7mg/dL和27.5%）；高于这些值被认为表明GV较高。采用逻辑回归模型来探讨有糖尿病和无糖尿病患者的GV与死亡率之间的关联。
结果
总共628例患者被分为SD<44.7mg/dL组（n=357）与SD≥44.7mg/dL组（n=271），以及CV<27.5%组（n=318）与CV≥27.5%组（n=310）。在控制年龄、性别、糖尿病（DM）和心血管疾病的存在后，我们发现高GV与死亡率之间存在显著关联（SD的比值比为2.99[1.88 - 4.77]，CV的比值比为2.43[1.54 - 3.85]；p值<0.001）。无论是否患有DM，SD≥44.7mg/dL和CV≥27.5%时的死亡率均高于SD<44.7mg/dL和CV<27.5%时（所有p值<0.001）。
结论
高血糖变异性与COVID-19住院的有糖尿病和无糖尿病患者的死亡率独立相关。
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