在一所三级转诊教学医院对非重症监护病房入院患者进行回顾性观察研究，以探讨入院后第二个24小时内的血糖峰值与医院获得性并发症之间的关联。

Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital.

作者信息

Depczynski Barbara, Kibret Getiye Dejenu, Georgiou Andrew, Lau Sue Mei

机构信息

Department of Diabetes and Endocrinology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia

UNSW, Sydney, New South Wales, Australia.

出版信息

BMJ Open. 2025 Jan 14;15(1):e089652. doi: 10.1136/bmjopen-2024-089652.

DOI:10.1136/bmjopen-2024-089652

PMID:39809558

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11752049/

Abstract

INTRODUCTION

Stress hyperglycaemia at hospital presentation is associated with poorer outcomes. Less is known about the risk of poorer outcomes according to achieved glycaemia early in the admission.

RESEARCH DESIGN/METHODS: This was a retrospective observational study of patients admitted to non-critical care wards. The aim was to determine the relationship between the day 2 peak blood glucose and the occurrence of hospital-acquired complications (HACs) or in-hospital mortality. A Cox proportional hazards model, adjusted for relevant covariates, was used to evaluate the impact of day 2 peak glucose on HACs and in-hospital mortality, and we identified peak glucose thresholds correlating with an increase in risk.

RESULTS

For the whole cohort, day 2 peak glucose was associated with an increased risk of any HAC, aHR=1.06, 95% CI: 1.04, 1.07; but not in-hospital mortality, aHR=0.98, 95% CI: 0.94, 1.01. The risk of HAC infection increased by 4.6% for every mmol/L rise in day 2 peak glucose (aHR=1.05, 95% CI: 1.02, 1.08) in the diabetes cohort compared with 5.5% (aHR=1.06, 95% CI: 1.00, 1.11) in the non-diabetes cohort. The risk of HAC cardiac in the diabetes cohort increased by 5.3% (aHR=1.05, CI: 1.01, 1.10) per mmol/L increase in day 2 peak glucose; no association was found in the non-diabetes cohort (aHR=1.03, 95% CI: 0.94, 1.13). The risk for in-hospital mortality was associated with day 2 peak glucose, aHR=1.11, 95% CI: 1.03, 1.20, in patients without diabetes, but not in patients with diabetes, aHR=1.00, 95% CI: 0.95, 1.06. There was an increase in the risk of HAC once day 2 peak blood glucose exceeded 19.0 mmol/L (whole cohort), with thresholds of 13.6 mmol/L in the non-diabetes group and 19.5 mmol/L in the diabetes group.

CONCLUSION

The peak glucose on day 2 was a predictor of HAC in the entire cohort and in-hospital mortality in patients without diabetes.

摘要

引言

入院时出现应激性高血糖与较差的预后相关。关于入院早期血糖控制情况对预后不良风险的影响，我们了解得较少。

研究设计/方法：这是一项针对入住非重症监护病房患者的回顾性观察性研究。目的是确定入院第2天的血糖峰值与医院获得性并发症（HAC）的发生或院内死亡率之间的关系。使用经相关协变量调整的Cox比例风险模型来评估入院第2天血糖峰值对HAC和院内死亡率的影响，并确定与风险增加相关的血糖峰值阈值。

结果

对于整个队列，入院第2天的血糖峰值与任何HAC风险增加相关，调整后风险比（aHR）=1.06，95%置信区间（CI）：1.04，1.07；但与院内死亡率无关，aHR=0.98，95%CI：0.94，1.01。糖尿病队列中，入院第2天血糖峰值每升高1 mmol/L，HAC感染风险增加4.6%（aHR=1.05，95%CI：1.02，1.08），而非糖尿病队列中增加5.5%（aHR=1.06，95%CI：1.00，1.11）。糖尿病队列中，入院第2天血糖峰值每升高1 mmol/L，HAC心脏相关并发症风险增加5.3%（aHR=1.05，CI：1.01，1.10）；非糖尿病队列中未发现关联（aHR=1.03，95%CI：0.94，1.13）。在无糖尿病患者中，院内死亡率风险与入院第2天血糖峰值相关，aHR=1.11，95%CI：1.03，1.20，而糖尿病患者中无此关联，aHR=1.00，95%CI：0.95，1.06。一旦入院第2天血糖峰值超过19.0 mmol/L（整个队列），HAC风险增加，非糖尿病组阈值为13.6 mmol/L，糖尿病组为19.5 mmol/L。