Zhang Shuo, Ji Jiaqi, Gao Siqi, Yang Shu, Song Zeyi, Li Jianmin, Liu Junjie
College of Clinical Medicine, North China University of Science and Technology, Tangshan, China.
School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, China.
Front Neurol. 2024 Mar 12;15:1344000. doi: 10.3389/fneur.2024.1344000. eCollection 2024.
This study aimed to evaluate the SpO (transcutaneous oxygen saturation) -mortality link in elderly T2DM (diabetes mellitus type 2) patients with cerebral infarction and identify their optimal SpO range.
In this investigation, we employed a comprehensive approach. Initially, we screened the MIMIC-IV database, identifying elderly T2DM patients with cerebral infarction, utilizing specific ICD-9 and ICD-10 codes. We then harnessed the power of restricted cubic splines to craft a visual representation of the correlation between SpO and 1-year mortality. To enhance our analysis, we harnessed Cox multivariate regression, allowing us to compute adjusted hazard ratios (HR) accompanied by 95% confidence intervals (CIs). Additionally, we crafted Cumulative Mortality Curve analyses, augmenting our study by engaging in rigorous subgroup analyses, stratifying our observations based on pertinent covariates.
In this study, 448 elderly T2DM patients with cerebral infarction were included. Within 1-year post-discharge, 161 patients (35.94%) succumbed. Employing Restricted Cubic Spline analysis, a statistically significant -shaped non-linear relationship between admission ICU SpO levels and 1-year mortality was observed (-value < 0.05). Further analysis indicated that both low and high SpO levels increased the mortality risk. Cox multivariate regression analysis, adjusting for potential confounding factors, confirmed the association of low (≤94.5%) and high SpO levels (96.5-98.5%) with elevated 1-year mortality risk, particularly notably high SpO levels (>98.5%) [HR = 2.06, 95% CI: 1.29-3.29, -value = 0.002]. The cumulative mortality curves revealed the following SpO subgroups from high to low cumulative mortality at the 365th day: normal levels (94.5% < SpO ≤ 96.5%), low levels (SpO ≤ 94.5%), high levels (96.5% < SpO ≤ 98.5%), and notably high levels (>98.5%). Subgroup analysis demonstrated no significant interaction between SpO and grouping variables, including Sex, Age, Congestive heart failure, Temperature, and ICU length of stay (LOS-ICU; -values for interaction were >0.05).
Striking an optimal balance is paramount, as fixating solely on lower SpO limits or neglecting high SpO levels may contribute to increased mortality rates. To mitigate mortality risk in elderly T2DM patients with cerebral infarction, we recommend maintaining SpO levels within the range of 94.5-96.5%.
本研究旨在评估老年2型糖尿病（T2DM）合并脑梗死患者的经皮血氧饱和度（SpO）与死亡率之间的关联，并确定其最佳SpO范围。
在本调查中，我们采用了综合方法。首先，我们筛选了MIMIC-IV数据库，利用特定的ICD-9和ICD-10编码识别老年T2DM合并脑梗死患者。然后，我们利用受限立方样条来绘制SpO与1年死亡率之间相关性的直观图。为了加强分析，我们采用Cox多变量回归，从而能够计算调整后的风险比（HR）以及95%置信区间（CI）。此外，我们绘制了累积死亡率曲线分析，通过基于相关协变量对观察结果进行分层的严格亚组分析来扩充我们的研究。
本研究纳入了448例老年T2DM合并脑梗死患者。出院后1年内，161例患者（35.94%）死亡。采用受限立方样条分析，观察到入院时重症监护病房（ICU）的SpO水平与1年死亡率之间存在具有统计学意义的非线性关系（P值<0.05）。进一步分析表明，SpO水平过低和过高均会增加死亡风险。在对潜在混杂因素进行调整的Cox多变量回归分析中，证实SpO水平过低（≤94.5%）和过高（96.5% - 98.5%）与1年死亡风险升高相关，尤其是SpO水平过高（>98.5%）[HR = 2.06，95%CI：1.29 - 3.29，P值 = 0.002]。累积死亡率曲线显示，在第365天时，从高到低累积死亡率的SpO亚组依次为：正常水平（94.5% < SpO ≤ 96.5%）、低水平（SpO ≤ 94.5%）、高水平（96.5% < SpO ≤ 98.5%）和极高水平（>98.5%）。亚组分析表明，SpO与分组变量（包括性别、年龄、充血性心力衰竭、体温和ICU住院时长（LOS-ICU））之间无显著交互作用（交互作用的P值>0.05）。
至关重要的是要达到最佳平衡，因为仅关注较低的SpO下限或忽视较高的SpO水平可能会导致死亡率增加。为降低老年T2DM合并脑梗死患者的死亡风险，我们建议将SpO水平维持在94.5% - 96.5%的范围内。
