Hryciw Brett N, Ghossein Jamie, Rochwerg Bram, Meggison Hilary, Fernando Shannon M, Kyeremanteng Kwadwo, Tran Alexandre, Seely Andrew J E
Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Crit Care Explor. 2024 Jan 11;6(1):e1025. doi: 10.1097/CCE.0000000000001025. eCollection 2024 Jan.
To perform a systematic review and meta-analysis to evaluate the association of various measures of glycemic variability, including time-domain and complexity-domain, with short-term mortality in patients with critical illness.
We searched Embase Classic +, MEDLINE, and the Cochrane Database of Systematic Reviews from inception to November 3, 2023.
We included English language studies that assessed metrics of glycemic variation or complexity and short-term mortality in patients admitted to the ICU.
Two authors performed independent data abstraction and risk-of-bias assessments. We used a random-effects model to pool binary and continuous data and summarized estimates of effect using odds ratios and mean difference. We used the Quality in Prognosis Studies tool to assess risk of bias and the Grading of Recommendations, Assessment, Development and Evaluations to assess certainty of pooled estimates.
We included 41 studies ( = 162,259). We demonstrate that increased sd, coefficient of variance, glycemic lability index, and decreased time in range are probably associated with increased mortality in critically ill patients (moderate certainty) and that increased mean absolute glucose, mean amplitude of glycemic excursion, and detrended fluctuation analysis may be associated with increased mortality (low certainty).
We found a consistent association between increased measures of glycemic variability and higher short-term mortality in patient with critical illness. Further research should focus on standardized measurements of glycemic variation and complexity, along with their utility as therapeutic targets and prognostic markers.
进行一项系统评价和荟萃分析，以评估包括时域和复杂度域在内的各种血糖变异性指标与危重症患者短期死亡率之间的关联。
我们检索了自建库至2023年11月3日的Embase Classic +、MEDLINE和Cochrane系统评价数据库。
我们纳入了评估入住重症监护病房（ICU）患者血糖变化或复杂度指标以及短期死亡率的英文研究。
两位作者独立进行数据提取和偏倚风险评估。我们使用随机效应模型汇总二分类和连续性数据，并使用比值比和平均差汇总效应估计值。我们使用预后研究质量工具评估偏倚风险，并使用推荐分级、评估、制定与评价方法评估汇总估计值的确定性。
我们纳入了41项研究（n = 162,259）。我们证明，标准差增加、变异系数、血糖波动指数增加以及血糖在目标范围内时间减少可能与危重症患者死亡率增加相关（中等确定性），而平均绝对血糖增加、血糖波动幅度均值增加和去趋势波动分析可能与死亡率增加相关（低确定性）。
我们发现危重症患者血糖变异性增加的指标与较高的短期死亡率之间存在一致的关联。进一步的研究应侧重于血糖变化和复杂度的标准化测量，以及它们作为治疗靶点和预后标志物的效用。
