埃博拉病毒病中的糖代谢紊乱：2018 年至 2020 年疫情的回顾性分析。

Dysglycaemia in Ebola virus disease: a retrospective analysis from the 2018 to 2020 outbreak.

机构信息

School of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo; School of Public Health, University of Alberta, Edmonton, AB, Canada.

Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.

出版信息

EBioMedicine. 2024 Aug;106:105241. doi: 10.1016/j.ebiom.2024.105241. Epub 2024 Jul 8.

DOI:10.1016/j.ebiom.2024.105241

PMID:38981161

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11292428/

Abstract

BACKGROUND

Ebola virus disease (EVD) is associated with multisystem organ failure and high mortality. Severe hypoglycaemia is common, life-threatening, and correctable in critically ill patients, but glucose monitoring may be limited in EVD treatment units.

METHODS

We conducted a retrospective review of patients admitted to EVD treatment units in Butembo and Katwa, Eastern DRC. Glucose measurements were done using a handheld glucometer at the bedside or using the Piccolo xpress Chemistry Analyzer on venous samples.

FINDINGS

384 patients (median age 30 years (interquartile range, IQR, 20-45), 57% female) and 6422 glucose measurements (median 11 per patient, IQR 4-22) were included in the analysis. Severe hypoglycaemia (≤2.2 mmol/L) and hyperglycaemia (>10 mmol/L) were recorded at least once during the ETU admission in 97 (25%) and 225 (59%) patients, respectively. A total of 2004 infusions of glucose-containing intravenous solutions were administered to 302 patients (79%) with a median cumulative dose of 175g (IQR 100-411). The overall case fatality rate was 157/384 (41%) and was 2.2-fold higher (95% CI 1.3-3.8) in patients with severe hypoglycaemia than those without hypoglycaemia (p = 0.0042). In a multivariable Cox proportional hazards model, periods of severe hypoglycaemia (adjusted hazard ratio (aHR) 6.2, 95% CI 3.2-12, p < 0.0001) and moderate hypoglycaemia (aHR 3.0, 95% CI 1.9-4.8, p < 0.0001) were associated with elevated mortality.

INTERPRETATION

Hypoglycaemia is common in EVD, requires repeated correction with intravenous dextrose solutions, and is associated with mortality.

FUNDING

This study was not supported by any specific funding.

摘要

背景

埃博拉病毒病（EVD）与多系统器官衰竭和高死亡率有关。严重低血糖很常见，对危重症患者有生命威胁，但在 EVD 治疗单位可能无法进行血糖监测。

方法

我们对刚果民主共和国东部贝滕博和卡塔的 EVD 治疗单位收治的患者进行了回顾性分析。床边使用手持式血糖仪或使用 Piccolo xpress Chemistry Analyzer 对静脉样本进行葡萄糖测量。

结果

共纳入 384 例患者（中位年龄 30 岁（四分位距 IQR，20-45），57%为女性）和 6422 次血糖测量值（每位患者中位 11 次，IQR 4-22）。97 例（25%）和 225 例（59%）患者至少在 ETU 住院期间记录到一次严重低血糖（≤2.2mmol/L）和高血糖（>10mmol/L）。302 例患者（79%）共输注含葡萄糖的静脉溶液 2004 次，中位累积剂量为 175g（IQR 100-411）。总病死率为 384 例中的 157 例（41%），严重低血糖患者的病死率是无低血糖患者的 2.2 倍（95%CI 1.3-3.8）（p=0.0042）。在多变量 Cox 比例风险模型中，严重低血糖（校正风险比[aHR]6.2，95%CI 3.2-12，p<0.0001）和中度低血糖（aHR 3.0，95%CI 1.9-4.8，p<0.0001）与死亡率升高相关。