Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Department of Geriatric Intensive Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Sci Rep. 2024 Feb 27;14(1):4721. doi: 10.1038/s41598-024-55504-9.
Blood glucose management in intensive care units (ICU) remains a controversial topic. We assessed the association between time-weighted average glucose (TWAG) levels and ICU mortality in critically ill patients in a real-world study. This retrospective study included critically ill patients from the Medical Information Mart for Intensive Care IV database. Glycemic distance is the difference between TWAG in the ICU and preadmission usual glycemia assessed with glycated hemoglobin at ICU admission. The TWAG and glycemic distance were divided into 4 groups and 3 groups, and their associations with ICU mortality risk were evaluated using multivariate logistic regression. Restricted cubic splines were used to explore the non-linear relationship. A total of 4737 adult patients were included. After adjusting for covariates, compared with TWAG ≤ 110 mg/dL, the odds ratios (ORs) of the TWAG > 110 mg/dL groups were 1.62 (95% CI 0.97-2.84, p = 0.075), 3.41 (95% CI 1.97-6.15, p < 0.05), and 6.62 (95% CI 3.6-12.6, p < 0.05). Compared with glycemic distance at - 15.1-20.1 mg/dL, the ORs of lower or higher groups were 0.78 (95% CI 0.50-1.21, p = 0.3) and 2.84 (95% CI 2.12-3.82, p < 0.05). The effect of hyperglycemia on ICU mortality was more pronounced in non-diabetic and non-septic patients. TWAG showed a U-shaped relationship with ICU mortality risk, and the mortality risk was minimal at 111 mg/dL. Maintaining glycemic distance ≤ 20.1 mg/dL may be beneficial. In different subgroups, the impact of hyperglycemia varied.
重症监护病房（ICU）的血糖管理仍然是一个有争议的话题。我们在一项真实世界的研究中评估了危重患者的时间加权平均血糖（TWAG）水平与 ICU 死亡率之间的关联。这项回顾性研究纳入了来自医疗信息集市重症监护 IV 数据库的危重患者。血糖差距是 ICU 中 TWAG 与 ICU 入院时糖化血红蛋白评估的入院前通常血糖之间的差异。将 TWAG 和血糖差距分为 4 组和 3 组，使用多变量逻辑回归评估它们与 ICU 死亡率风险的关系。采用限制立方样条探索非线性关系。共纳入 4737 例成年患者。在调整了协变量后，与 TWAG≤110mg/dL 相比，TWAG>110mg/dL 组的比值比（OR）分别为 1.62（95%可信区间为 0.97-2.84，p=0.075）、3.41（95%可信区间为 1.97-6.15，p<0.05）和 6.62（95%可信区间为 3.6-12.6，p<0.05）。与血糖差距在-15.1-20.1mg/dL 相比，较低或较高组的 OR 分别为 0.78（95%可信区间为 0.50-1.21，p=0.3）和 2.84（95%可信区间为 2.12-3.82，p<0.05）。高血糖对 ICU 死亡率的影响在非糖尿病和非脓毒症患者中更为明显。TWAG 与 ICU 死亡率风险呈 U 型关系，在 111mg/dL 时死亡率风险最小。维持血糖差距≤20.1mg/dL 可能是有益的。在不同亚组中，高血糖的影响不同。
