2019年冠状病毒病危重症患者血糖变异性的影响：一项回顾性观察研究
Effects of Glycemic Variability in Critically Ill Patients with Coronavirus Disease 2019: A Retrospective Observational Study.
作者信息
Boschi Emerson, Friedman Gilberto, Moraes Rafael B
机构信息
Hospital Geral de Caxias do Sul, Postgraduate Program in Pneumological Sciences of Universidade Federal do Rio Grande do Sul (UFRGS); (RS, Brazil).
Programa de Pos-graduacao em Ciencias Pneumologicas, Universidade Federal do Rio Grande do Sul - School of Medicine, Porto Alegre, Rio Grande do Sul, Brazil.
出版信息
Indian J Crit Care Med. 2024 Apr;28(4):381-386. doi: 10.5005/jp-journals-10071-24688.
AIM AND BACKGROUND
Hyperglycemia is considered an adaptive metabolic manifestation of stress and is associated with poor outcomes. Herein, we analyzed the association between glycemic variability (GV) and hospital mortality in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU), and the association between GV and mechanical ventilation (MV), ICU stay, length of hospital stays, renal replacement therapy (RRT), hypoglycemia, nosocomial infections, insulin use, and corticosteroid class.
MATERIALS AND METHODS
In this retrospective observational study, we collected information on blood glucose levels during the first 10 days of hospitalization in a cohort of ICU patients with COVID-19 and its association with outcomes.
RESULTS
In 239 patients, an association was observed between GV and hospital mortality between the first and last quartiles among patients without diabetes [odds ratio (OR), 3.78; confidence interval, 1.24-11.5]. A higher GV was associated with a greater need for RRT ( = 0.002), regular insulin ( < 0.001), and episodes of hypoglycemia ( < 0.001). Nosocomial infections were associated with intermediate GV quartiles ( = 0.02). The corticosteroid class had no association with GV ( = 0.21).
CONCLUSION
Glycemic variability was associated with high mortality in patients with COVID-19 and observed in the subgroup of patients without diabetes.
CLINICAL SIGNIFICANCE
Glycemic control in critically ill patients remains controversial and hyperglycemia is associated with worse outcomes. Diabetes mellitus (DM) is one of the most prevalent comorbidities in patients with COVID-19. In addition, they require corticosteroids due to pulmonary involvement, representing a challenge and an opportunity to better understand how glycemic changes can influence the outcome of these patients.
HOW TO CITE THIS ARTICLE
Boschi E, Friedman G, Moraes RB. Effects of Glycemic Variability in Critically Ill Patients with Coronavirus Disease 2019: A Retrospective Observational Study. Indian J Crit Care Med 2024;28(4):381-386.
目的与背景
高血糖被认为是应激的一种适应性代谢表现，且与不良预后相关。在此，我们分析了2019冠状病毒病（COVID-19）重症监护病房（ICU）患者的血糖变异性（GV）与医院死亡率之间的关联，以及GV与机械通气（MV）、ICU住院时间、住院时长、肾脏替代治疗（RRT）、低血糖、医院感染、胰岛素使用和糖皮质激素类别之间的关联。
材料与方法
在这项回顾性观察研究中，我们收集了一组COVID-19 ICU患者住院前10天的血糖水平信息及其与预后的关联。
结果
在239例患者中，未患糖尿病患者的GV与医院死亡率在第一个和最后一个四分位数之间存在关联[比值比（OR），3.78；置信区间，1.24 - 11.5]。较高的GV与更大的RRT需求（ = 0.002）、常规胰岛素需求（ < 0.001）和低血糖发作（ < 0.001）相关。医院感染与中等GV四分位数相关（ = 0.02）。糖皮质激素类别与GV无关联（ = 0.21）。
结论
血糖变异性与COVID-19患者的高死亡率相关，且在未患糖尿病的患者亚组中观察到。
临床意义
重症患者的血糖控制仍存在争议，高血糖与更差的预后相关。糖尿病（DM）是COVID-19患者中最常见的合并症之一。此外，由于肺部受累，他们需要使用糖皮质激素，这代表了一个挑战和一个更好地理解血糖变化如何影响这些患者预后的机会。
如何引用本文
Boschi E, Friedman G, Moraes RB. Effects of Glycemic Variability in Critically Ill Patients with Coronavirus Disease 2019: A Retrospective Observational Study. Indian J Crit Care Med 2024;28(4):381 - 386.
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