心脏重症监护病房中应激性高血糖比率与全因死亡率风险之间的U型关联。

U-shaped association between stress hyperglycemia ratio and risk of all-cause mortality in cardiac ICU.

作者信息

Li Le, Ding Ligang, Zheng Lihui, Wu Lingmin, Hu Zhicheng, Liu Limin, Zhang Zhuxin, Zhou Likun, Yao Yan

机构信息

Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China.

出版信息

Diabetes Metab Syndr. 2024 Jan;18(1):102932. doi: 10.1016/j.dsx.2023.102932. Epub 2023 Dec 20.

DOI:10.1016/j.dsx.2023.102932

PMID:38147811

Abstract

BACKGROUND

Stress hyperglycemia has been associated with poor prognosis in patients admitted to the cardiac intensive care unit (ICU). Recently, the stress hyperglycemia ratio (SHR) has been proposed to reflect true acute hyperglycemic. This study aimed to investigate the relationship between SHR and prognosis of patients in the cardiac ICU.

METHODS

A retrospective analysis was conducted on a cohort of 5,564 patients admitted to the cardiac ICU. The participants were divided into seven groups based on their SHR levels. SHR was calculated as admission blood glucose/[(28.7 × HbA1c %) - 46.7]. The primary outcomes of this study were 28-day all-cause mortality.

RESULTS

During the follow-up period, 349 (6.3%) patients succumbed within 28 days. A U-shaped correlation between SHR and mortality persisted, even after adjusting for other confounding variables, with a discernible inflection point at 0.95. When SHR surpassed 0.95, each standard deviation (SD) increase corresponded to a 1.41-fold elevation in the risk of mortality (odds ratio [OR]: 1.41, 95% CI: 1.25 to 1.59). In contrast, when SHR fell below 0.95, each SD increment correlated with a significantly reduced risk of mortality (OR: 0.56, 95% CI: 0.34 to 0.91).

CONCLUSION

There was a U-shaped association between SHR and short -term mortality in patients in the cardiac ICU. The inflection point of SHR for poor prognosis was identified at an SHR value of 0.95.

摘要

背景

应激性高血糖与入住心脏重症监护病房（ICU）患者的不良预后相关。最近，有人提出应激性高血糖比值（SHR）来反映真正的急性高血糖情况。本研究旨在探讨SHR与心脏ICU患者预后之间的关系。

方法

对5564例入住心脏ICU的患者进行回顾性分析。根据SHR水平将参与者分为七组。SHR的计算方法为入院血糖/[（28.7×糖化血红蛋白百分比）-46.7]。本研究的主要结局是28天全因死亡率。

结果

在随访期间，349例（6.3%）患者在28天内死亡。即使在调整其他混杂变量后，SHR与死亡率之间仍存在U型相关性，在0.95处有一个明显的拐点。当SHR超过0.95时，每增加一个标准差（SD），死亡风险升高1.41倍（比值比[OR]：1.41，95%置信区间：1.25至1.59）。相反，当SHR低于0.95时，每增加一个SD，死亡风险显著降低（OR：0.56，95%置信区间：0.34至0.91）。