Glucose variability is associated with intensive care unit mortality
Glucose variability is associated with intensive care unit mortality
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DOI：
10.1097/ccm.0b013e3181cc4be9
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发表时间：
2010-03-01
影响因子：
8.8
通讯作者：
DeVries, J. Hans
中科院分区：
文献类型：
--
作者：
Hermanides, Jeroen;Vriesendorp, Titia M.;DeVries, J. Hans
目的：越来越多的证据表明血糖变异性在预测重症监护病房（ICU）死亡率中的作用。我们调查了血糖变异性与重症监护室和院内死亡之间的关系，这些变化跨越了几个平均血糖范围。设计：回顾性队列研究。设置：教学医院的一个18床内科/外科ICU。患者：2004年1月至2007年12月期间入住ICU的所有患者。干预措施：无。测量和主要结果：计算了5728例患者的两个变异性指标，即每小时平均绝对葡萄糖变化和SD，作为葡萄糖变异性指标，并使用logistic回归分析与ICU和院内死亡相关。计算平均血糖四分位数间每小时平均绝对血糖变化的死亡率和ICU死亡的校正比值比。患者接受计算机化胰岛素算法治疗（目标血糖72-126 mg/dL）。平均年龄为65 ± 13岁，34%为女性，6.3%的患者死于ICU。与平均血糖或SD的四分位数相比，每小时平均绝对血糖变化的四分位数的ICU死亡的比值比更高。ICU死亡的最高比值比发现于血糖上四分位数中每小时平均绝对血糖变化最高的患者：比值比12.4（95%置信区间，3.2-47.9; p
Objective: Mounting evidence suggests a role for glucose variability in predicting intensive care unit (ICU) mortality. We investigated the association between glucose variability and intensive care unit and in-hospital deaths across several ranges of mean glucose.Design: Retrospective cohort study.Setting: An 18-bed medical/surgical ICU in a teaching hospital.Patients: All patients admitted to the ICU from January 2004 through December 2007.Interventions: None.Measurements and Main Results: Two measures of variability, mean absolute glucose change per hour and SD, were calculated as measures of glucose variability from 5728 patients and were related to ICU and in-hospital death using logistic regression analysis. Mortality rates and adjusted odds ratios for ICU death per mean absolute glucose change per hour quartile across quartiles of mean glucose were calculated. Patients were treated with a computerized insulin algorithm (target glucose 72-126 mg/dL). Mean age was 65 +/- 13 yrs, 34% were female, and 6.3% of patients died in the ICU. The odds ratios for ICU death were higher for quartiles of mean absolute glucose change per hour compared with quartiles of mean glucose or SD. The highest odds ratio for ICU death was found in patients with the highest mean absolute glucose change per hour in the upper glucose quartile: odds ratio 12.4 (95% confidence interval, 3.2-47.9; p