Long Chuyan, Fan Weiguo, Liu Yang, Hong Kui
Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Department of Genetic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Front Endocrinol (Lausanne). 2024 Feb 23;15:1302537. doi: 10.3389/fendo.2024.1302537. eCollection 2024.
Stress hyperglycemia is common in critically ill patients and is associated with poor prognosis. Whether this association exists in pulmonary hypertension (PH) patients is unknown. The present cohort study investigated the association of stress hyperglycemia with 90-day all-cause mortality in intensive care unit (ICU) patients with PH.
Data of the study population were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. A new index, the ratio of admission glucose to HbA1c (GAR), was used to evaluate stress hyperglycemia. The study population was divided into groups according to GAR quartiles (Q1-Q4). The outcome of interest was all-cause mortality within 90 days, which was considered a short-term prognosis.
A total of 53,569 patients were screened. Ultimately, 414 PH patients were enrolled; 44.2% were male, and 23.2% were admitted to the cardiac ICU. As the GAR increased from Q2 to Q4, the groups had lower creatinine levels, longer ICU stays, and a higher proportion of renal disease. After adjusting for confounding factors such as demographics, vital signs, and comorbidities, an elevated GAR was associated with an increased risk of 90-day mortality.
Stress hyperglycemia assessed by the GAR was associated with increased 90-day mortality in ICU patients with PH.
应激性高血糖在危重症患者中很常见，且与预后不良相关。这种关联在肺动脉高压（PH）患者中是否存在尚不清楚。本队列研究调查了应激性高血糖与PH重症监护病房（ICU）患者90天全因死亡率之间的关联。
研究人群的数据从重症监护医学信息集市IV（MIMIC-IV）数据库中提取。使用一种新的指标，即入院血糖与糖化血红蛋白（HbA1c）的比值（GAR）来评估应激性高血糖。根据GAR四分位数（Q1-Q4）将研究人群分组。感兴趣的结局是90天内的全因死亡率，其被视为短期预后。
共筛选出53569例患者。最终，纳入了414例PH患者；44.2%为男性，23.2%入住心脏ICU。随着GAR从Q2升高到Q4，各组肌酐水平降低、ICU住院时间延长且肾病比例更高。在调整了人口统计学、生命体征和合并症等混杂因素后，GAR升高与90天死亡风险增加相关。
通过GAR评估的应激性高血糖与PH的ICU患者90天死亡率增加相关。
