急性缺血性中风患者血糖水平轨迹与30天死亡风险之间的关联：对2001 - 2019年MIMIC数据库的分析
Association between blood glucose level trajectories and 30-day mortality risk in patients with acute ischemic stroke: analysis of the MIMIC database 2001-2019.
作者信息
Li Li, Xing Xiaolian, Li Qian, Zhang Qinqin, Meng Zhijun
机构信息
Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, 030012, P.R. China.
Department of Neurology, Taiyuan City Central Hospital, Taiyuan, 030009, P.R. China.
出版信息
Diabetol Metab Syndr. 2024 Oct 19;16(1):249. doi: 10.1186/s13098-024-01482-x.
BACKGROUND
Hyperglycemia is one of the most common comorbidities in patients with acute ischemic stroke (AIS). This study aimed to assess the impact of short-term longitudinal blood glucose level change trajectories on the 30-day mortality risk in patients with AIS.
METHODS
Data for AIS patients were obtained from the 2001-2019 Medical Information Mart for Intensive Care (MIMIC) database. The latent growth mixture modeling (LGMM) was utilized to classify a patient's blood glucose level trajectory within 24 h of admission. Cox regression analyses were applied to examine the relationship between blood glucose levels at admission and blood glucose level trajectories and the risk of 30-day mortality in patients with AIS.
RESULTS
A total of 2,432 patients with AIS were included in this retrospective cohort study, with 30-day mortality occurring in 574 (23.60%) patients. The median glucose levels of all patients were 136.00 (110.00, 178.00) mg/dL. Four blood glucose level trajectories were identified: low level-stable trend (type 1), moderate level-stable trend (type 2), high level-decreasing-increasing trend (type 3), and moderate level-increasing-decreasing trend (type 4). Type 2 blood glucose level trajectory was associated with an increased risk of 30-day mortality compared with type 1 blood glucose level trajectory [hazard ratio (HR) = 1.28, 95% confidence interval (CI): 1.03-1.59), but there were no significant associations between type 3 (HR = 1.16, 95%CI: 0.77-1.74) and type 4 (HR = 1.44, 95%CI: 0.84-2.45) trajectories and 30-day mortality risk. Subgroup analysis demonstrated that the association between type 2 trajectory and 30-day mortality risk was observed in patients aged ≥ 65 years (HR = 1.37, 95%CI: 1.05-1.79), female (HR = 1.42, 95%CI: 1.05-1.94), with (HR = 1.44, 95%CI: 1.02-2.02) or without (HR = 1.42, 95%CI: 1.01-1.99) diabetes, and not using insulin (HR = 2.80, 95%CI: 1.43-5.49).
CONCLUSION
AIS patients with consistently high blood glucose levels within 24 h of admission increased the risk of 30-day mortality.
背景
高血糖是急性缺血性卒中（AIS）患者最常见的合并症之一。本研究旨在评估短期纵向血糖水平变化轨迹对AIS患者30天死亡风险的影响。
方法
AIS患者的数据来自2001 - 2019年重症监护医学信息数据库（MIMIC）。采用潜在增长混合模型（LGMM）对患者入院24小时内的血糖水平轨迹进行分类。应用Cox回归分析来检验入院时血糖水平和血糖水平轨迹与AIS患者30天死亡风险之间的关系。
结果
本回顾性队列研究共纳入2432例AIS患者，其中574例（23.60%）患者在30天内死亡。所有患者的血糖中位数为136.00（110.00，178.00）mg/dL。识别出四种血糖水平轨迹：低水平 - 稳定趋势（1型）、中等水平 - 稳定趋势（2型）、高水平 - 先降后升趋势（3型）和中等水平 - 先升后降趋势（4型）。与1型血糖水平轨迹相比，2型血糖水平轨迹与30天死亡风险增加相关[风险比（HR）= 1.28，95%置信区间（CI）：1.03 - 1.59]，但3型（HR = 1.16，95%CI：0.77 - 1.74）和4型（HR = 1.44，95%CI：0.84 - 2.45）轨迹与30天死亡风险之间无显著关联。亚组分析表明，在年龄≥65岁的患者（HR = 1.37，95%CI：1.05 - 1.79）、女性（HR = 1.42，95%CI：1.05 - 1.94）、有（HR = 1.44，95%CI：1.02 - 2.02）或无（HR = 1.42，95%CI：1.01 - 1.99）糖尿病以及未使用胰岛素的患者（HR = 2.80，95%CI：1.43 - 5.49）中观察到2型轨迹与30天死亡风险之间的关联。
结论
入院24小时内血糖水平持续较高的AIS患者30天死亡风险增加。
Zotero 插件