Characterization of persistent hyperglycemia: what does it mean postinjury?
Characterization of persistent hyperglycemia: what does it mean postinjury?
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持续性高血糖的特征：受伤后意味着什么？
DOI：
10.1097/ta.0b013e31817db0de
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发表时间：
2009
期刊：
影响因子：
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通讯作者：
InflammationandtheHostResponsetoInjuryInvestigators
中科院分区：
文献类型：
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作者：
Sperry,JasonL;Frankel,HeidiL;Nathens,AveryB;O'keefe,GrantE;Cuschieri,Joseph;Moore,ErnestE;Maier,RonaldV;Minei,JosephP;InflammationandtheHostResponsetoInjuryInvestigators
背景资料：严格的血糖控制已被证明可以降低危重手术患者的发病率和死亡率;然而，过度积极的高血糖管理也可能与有害影响有关。我们试图描述与不同水平的持续性高血糖（PH）在严重受伤的创伤患者队列的临床结果，当一个严格的血糖控制协议（目标葡萄糖80-110 mg/dL）implemented.Methods：数据来自一个多中心的前瞻性队列研究，评估钝伤成人出血性休克的临床结果。使用从损伤后第2天（损伤后> 48小时）至损伤后第5天的平均最大每日葡萄糖值来分析血糖控制。PH被定义为平均葡萄糖值> 130 mg/dL，并基于队列的平均4天葡萄糖值的分布分为三个不同的严重程度水平（I-III）。单独的考克斯比例风险回归模型，然后被用来确定是否PH是独立相关的死亡率和医院感染（NI），血糖控制水平与这些不良outcomes.Results：总死亡率和NI率为研究人群（n= 862）分别为10.8%和49.6%，分别。考克斯比例风险回归分析显示，PH与平均4天血糖值> 145 mg/dL的患者（第II组）的死亡率增加近80%独立相关，与> 165 mg/dL的患者（第III组）的死亡率增加近两倍相关。然而，在任何水平上，PH与NI的高风险无关。PH患者早期多器官功能衰竭的发生率较高（在最初的48小时内：30.2%对41.6%，p= 0.001），在大多数patients.Conclusion：每日最高血糖值< 145 mg/dL的维持与损伤后的生存获益独立相关。PH患者，尽管积极的胰岛素治疗，有较高的多器官功能衰竭的发生率和相关的死亡率较高的风险。然而，在目前的创伤队列中严格的血糖控制方案似乎已经阻止了PH和感染并发症的关联，这在先前的研究中已有记录。该分析进一步验证了损伤后严格血糖控制的重要性，并强调了进一步研究这些发现的机制的必要性。
Background: Strict glycemic control has been shown to reduce both morbidity and mortality in critically ill surgical patients; however, overly aggressive management of hyperglycemia may also be associated with deleterious effects. We sought to characterize clinical outcomes associated with different levels of persistent hyperglycemia (PH) in a cohort of severely injured patients with trauma, when a strict glycemic control protocol (target glucose 80–110 mg/dL) was implemented.Methods: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Glycemic control was analyzed using the average maximum daily glucose values from postinjury day 2 (> 48 hours after injury) to postinjury day 5. PH was defined as a mean glucose value> 130 mg/dL, and was categorized into three different severity levels (I–III) based on the distribution of mean 4-day glucose values for the cohort. Separate Cox proportional hazard regression models were then used to determine whether PH was independently associated with mortality and nosocomial infection (NI), and the level of glycemic control that was associated with these poor outcomes.Results: Overall mortality and NI rates for the study population (n= 862) were 10.8% and 49.6%, respectively. Cox proportional hazard regression revealed that PH was independently associated with almost an 80% higher mortality in patients with mean 4-day glucose values> 145 mg/dL (group II) and almost a twofold higher mortality in patients with> 165 mg/dL (group III). However, PH was not independently associated with a higher risk of NI at any level. Patients with PH did have a higher incidence of early multiple organ failure (within first 48 hours: 30.2% vs. 41.6% p= 0.001), which preceded the documentation of PH in the majority of patients.Conclusion: Maintenance of daily maximum glucose values< 145 mg/dL was independently associated with a survival benefit after injury. Patients with PH, despite aggressive insulin therapy, had a higher incidence of multiple organ failure and an associated higher risk of mortality. However, the strict glycemic control protocol in the current trauma cohort seems to have prevented the association of PH and infectious complications, which has been documented in prior studies. This analysis further validates the importance of strict glycemic control after injury, and highlights the need for further studies on the mechanism responsible for these findings.