葡萄糖时间序列的复杂性与危重症成年患者的短期和长期死亡率相关：一项多中心、前瞻性、观察性研究。

The complexity of glucose time series is associated with short- and long-term mortality in critically ill adults: a multi-center, prospective, observational study.

机构信息

Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China.

Department of Anesthesiology, Tongji University Affiliated Shanghai Tenth People's Hospital, Shanghai, China.

出版信息

J Endocrinol Invest. 2024 Dec;47(12):3091-3099. doi: 10.1007/s40618-024-02393-4. Epub 2024 May 18.

DOI:10.1007/s40618-024-02393-4

PMID:38762634

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11549136/

Abstract

BACKGROUND

The wealth of data taken from continuous glucose monitoring (CGM) remains to be fully used. We aimed to evaluate the relationship between a promising new CGM metric, complexity of glucose time series index (CGI), and mortality in critically ill patients.

METHODS

A total of 293 patients admitted to mixed medical/surgical intensive care units from 5 medical centers in Shanghai were prospectively included between May 2020 and November 2021. CGI was assessed using intermittently scanned CGM, with a median monitoring period of 12.0 days. Outcome measures included short- and long-term mortality.

RESULTS

During a median follow-up period of 1.7 years, a total of 139 (47.4%) deaths were identified, of which 73 (24.9%) occurred within the first 30 days after ICU admission, and 103 (35.2%) within 90 days. The multivariable-adjusted HRs for 30-day mortality across ascending tertiles of CGI were 1.00 (reference), 0.68 (95% CI 0.38-1.22) and 0.36 (95% CI 0.19-0.70), respectively. For per 1-SD increase in CGI, the risk of 30-day mortality was decreased by 51% (HR 0.49, 95% CI 0.35-0.69). Further adjustment for HbA1c, mean glucose during hospitalization and glucose variability partially attenuated these associations, although the link between CGI and 30-day mortality remained significant (per 1-SD increase: HR 0.57, 95% CI 0.40-0.83). Similar results were observed when 90-day mortality was considered as the outcome. Furthermore, CGI was also significantly and independently associated with long-term mortality (per 1-SD increase: HR 0.77, 95% CI 0.61-0.97).

CONCLUSIONS

In critically ill patients, CGI is significantly associated with short- and long-term mortality.

摘要

背景

连续血糖监测（CGM）所获取的数据量巨大，但尚未得到充分利用。我们旨在评估一种有前途的新 CGM 指标——血糖时间序列复杂度指数（CGI）与危重症患者死亡率之间的关系。

方法

2020 年 5 月至 2021 年 11 月，我们前瞻性纳入了来自上海 5 家医疗中心的混合内科/外科重症监护病房的 293 名患者。使用间歇性扫描 CGM 评估 CGI，中位监测时间为 12.0 天。结局指标包括短期和长期死亡率。

结果

在中位 1.7 年的随访期间，共确定了 139 例（47.4%）死亡，其中 73 例（24.9%）发生在 ICU 入院后 30 天内，103 例（35.2%）发生在 90 天内。CGI 递增三分位组的 30 天死亡率的多变量调整 HR 分别为 1.00（参考）、0.68（95%CI 0.38-1.22）和 0.36（95%CI 0.19-0.70）。CGI 每增加 1-SD，30 天死亡率的风险降低 51%（HR 0.49，95%CI 0.35-0.69）。进一步调整糖化血红蛋白（HbA1c）、住院期间平均血糖和血糖变异性部分减弱了这些关联，但 CGI 与 30 天死亡率之间的关联仍然显著（每增加 1-SD：HR 0.57，95%CI 0.40-0.83）。当将 90 天死亡率作为结局时，也观察到了类似的结果。此外，CGI 与长期死亡率也显著相关（每增加 1-SD：HR 0.77，95%CI 0.61-0.97）。