Wang Yu-Dan, Yu Jing-Jing
Department of Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Ningbo 315300, Zhejiang Province, China.
Department of Critical Care Medicine, The Second People's Hospital of Beilun District, Ningbo 315809, Zhejiang Province, China.
World J Diabetes. 2025 Jul 15;16(7):107767. doi: 10.4239/wjd.v16.i7.107767.
Stress-induced hyperglycemia (SIH) is common in critically ill patients and has been associated with adverse cardiovascular outcomes. Intensive insulin therapy (IIT) has been proposed to mitigate these risks by achieving tighter glycemic control.
To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.
A retrospective study was conducted at our hospital from January 2021 to December 2024, adhering to STROBE guidelines. A total of 186 critically ill patients were divided into normal glycemia ( = 85) and SIH ( = 101) groups. The SIH cohort was further subdivided into conventional treatment ( = 50) and IIT ( = 51) groups. Hemodynamic parameters-including right atrial pressure (RAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), and B-type natriuretic peptide (BNP)-were measured at baseline and post-treatment. Clinical outcomes such as intensive care unit (ICU) length of stay, mechanical ventilation requirements, and mortality were also recorded. Statistical analyses were conducted using independent samples -tests and /Fisher's exact tests.
SIH markedly worsened haemodynamics versus normal glycaemia: RAP 9.8 ± 5.1 6.1 ± 3.5 mmHg, PAP 35.2 ± 16.0 26.2 ± 10.3 mmHg, PAWP 16.0 ± 7.0 8.6 ± 6.4 mmHg, CO 3.3 ± 2.3 6.0 ± 3.3 L/min, CI 1.88 ± 0.24 2.70 ± 0.50 L/min/m, BNP 465 ± 250 180 ± 53 pg/mL (all < 0.001). Within the SIH cohort, IIT outperformed conventional therapy: RAP 7.0 ± 2.2 8.3 ± 3.9 mmHg ( = 0.04), PAP 21.6 ± 3.7 29.3 ± 6.5 mmHg ( < 0.001), PAWP 10.2 ± 5.4 13.8 ± 5.3 mmHg ( = 0.001), CO 4.9 ± 2.2 4.0 ± 1.4 L/min ( = 0.022), CI 2.58 ± 0.32 2.11 ± 0.31 L/min/m, < 0.001), BNP 202 ± 62 346 ± 171 pg/mL ( < 0.001). Clinically, IIT shortened ICU stay (10.3 ± 3.4 14.5 ± 2.6 days, < 0.001), reduced ventilator use (56.9% 76.0%, = 0.042), and lowered mortality (23.5% 42.0%, = 0.048).
IIT significantly reduced cardiac filling pressures, improved cardiac function, and was associated with favorable clinical outcomes in SIH patients, suggesting potential benefits of stricter glycaemic control in critically ill patients. However, given the retrospective design and absence of glucose-variability monitoring, these findings should be interpreted with caution.
应激性高血糖（SIH）在重症患者中很常见，并且与不良心血管结局相关。有人提出强化胰岛素治疗（IIT）可通过实现更严格的血糖控制来降低这些风险。
评估IIT在管理重症患者SIH方面的疗效，并探讨其对心脏功能的潜在影响。
于2021年1月至2024年12月在我院进行了一项回顾性研究，遵循STROBE指南。总共186例重症患者被分为正常血糖组（n = 85）和SIH组（n = 101）。SIH队列进一步细分为传统治疗组（n = 50）和IIT组（n = 51）。在基线和治疗后测量血流动力学参数，包括右心房压（RAP）、肺动脉压（PAP）、肺毛细血管楔压（PAWP）、心输出量（CO）、心脏指数（CI）和B型利钠肽（BNP）。还记录了诸如重症监护病房（ICU）住院时间、机械通气需求和死亡率等临床结局。使用独立样本t检验和χ²/Fisher精确检验进行统计分析。
与正常血糖相比，SIH显著恶化了血流动力学：RAP为9.8±5.1对6.1±3.5 mmHg，PAP为35.2±16.0对26.2±10.3 mmHg，PAWP为16.0±7.0对8.6±6.4 mmHg，CO为3.3±2.3对6.0±3.3 L/min，CI为1.88±0.24对2.70±0.50 L/min/m²，BNP为465±250对180±53 pg/mL（均P < 0.001）。在SIH队列中，IIT的效果优于传统治疗：RAP为7.0±2.2对8.3±3.9 mmHg（P = 0.04），PAP为21.6±3.7对29.3±6.5 mmHg（P < 0.001），PAWP为1
