Association of Diabetes and Admission Blood Glucose Levels with Short-Term Outcomes in Patients with Critical Illnesses.
Association of Diabetes and Admission Blood Glucose Levels with Short-Term Outcomes in Patients with Critical Illnesses.
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DOI：
10.2147/jir.s287510
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发表时间：
2020
影响因子：
4.5
通讯作者：
Zeng M
中科院分区：
文献类型：
--
作者：
Lin S;He W;Zeng M
糖尿病和入院血糖对危重病患者短期预后的关系目前尚不明确。我们的目的是确定糖尿病和入院血糖是否影响危重患者的短期预后。我们对来自重症监护数据库的46，476例重症患者的数据进行了回顾性分析。糖尿病与28天死亡率的关联通过基于倾向评分的逆概率加权进行评估。应用平滑样条函数和阈值效应分析探讨入院血糖与临床结局的关系。在参加该研究的33，680名患者中，8，701名（25.83%）患有糖尿病。在主要分析中，与非糖尿病患者相比，糖尿病患者的28天死亡率降低了29%（风险比（HR）=0.71，95%置信区间（CI）0.67-0.76）。E值为2.17，表明对未测量的混杂因素具有稳健性。观察到ICU入院时血糖、入院类型和胰岛素使用的显著交互作用（交互作用P <0.05）。在非糖尿病患者中，入院血糖与28天死亡率之间呈V形关系，最低28天死亡率对应于血糖水平为101.75 mg/dl（95% CI 94.64-105.80 mg/dl），应避免入院低血糖或高血糖，尤其是在外科重症监护室（SICU）的患者中，心脏手术恢复室（CSRU）和冠心病监护室（CCU）;对于糖尿病患者，入院时血糖升高似乎与预后不良无关，除CCU和CSRU外，血糖升高可能有益。进一步证实了糖尿病对危重患者短期预后的无害影响，这将使28天死亡率降低约29%。对于非糖尿病患者，对应于最低28天死亡率的入院血糖水平为101.75 mg/dl（95% CI 94.64-105.80 mg/dl）;然而，对于糖尿病患者，适当的入院血糖阈值仍未确定。
Association of diabetes and admission glucose on the short-term prognosis in patients with critical illnesses are currently ambiguous. We aimed to determine whether diabetes and admission glucose affects short-term prognosis of critically ill patients. We performed a retrospective analysis of data on 46,476 critically ill patients from the critical care database. Association of diabetes with 28-day mortality was assessed by inverse probability weighting based on the propensity score. Smoothing splines and threshold effect analysis were applied to explore the relationship between admission glucose and clinical outcomes. Of the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetes. In the main analysis, the 28-day mortality was reduced by 29% (hazard ratio (HR)=0.71, 95% confidence interval (CI) 0.67–0.76) in patients with diabetes compared to those without diabetes. The E-value of 2.17 indicated robustness to unmeasured confounders. Significant interactions were observed for glucose at ICU admission, admission type, and insulin use (Interaction P <0.05). A V-shaped relationship was observed between admission glucose and 28-day mortality in non-diabetic patients, with the lowest 28-day mortality corresponding to a glucose level of 101.75 mg/dl (95% CI 94.64–105.80 mg/dl), and admission hypoglycemia or hyperglycemia should be avoided, especially in patients admitted to the surgical intensive care unit (SICU), cardiac surgery recovery unit (CSRU), and coronary care unit (CCU); for diabetic patients, elevated admission glucose does not appear to be associated with a poor prognosis and perhaps may be beneficial except for CCU and CSRU. The non-detrimental effect of diabetes on the short-term prognosis of critically ill patients was further confirmed, which would reduce 28-day mortality by approximately 29%. For non-diabetic patients, the admission glucose level corresponding to the lowest 28-day mortality was 101.75 mg/dl (95% CI 94.64–105.80 mg/dl); however, for diabetics, the appropriate admission glucose threshold remains unresolved.