Pre-morbid glycemic control modifies the interaction between acute hypoglycemia and mortality
Pre-morbid glycemic control modifies the interaction between acute hypoglycemia and mortality
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DOI：
10.1007/s00134-016-4216-8
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发表时间：
2016-04-01
影响因子：
38.9
通讯作者：
Bellomo, Rinaldo
中科院分区：
文献类型：
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作者：
Egi, Moritoki;Krinsley, James S.;Bellomo, Rinaldo
目的：为了研究发病前血糖控制对重症监护病房（ICU）患者急性低血糖和随后的危重病患者住院死亡率之间的关系的影响，我们对ICU入院前3个月内具有HbA 1c水平的患者进行了一项多中心、多国、回顾性观察研究。我们根据入院前HbA 1c水平将患者分为三个队列（分别为< 6.5，6.5-7.9，千分之一日元8.0%）。根据已发表的数据，我们将40-69 mg/dL（2.2-3.8 mmol/L）的葡萄糖浓度定义为中度低血糖，将< 40 mg/dL（< 2.2 mmol/L）定义为重度低血糖。我们应用logistic回归分析研究发病前血糖控制对急性低血糖与死亡率之间关系的影响。在这些患者中，随着HbA 1c水平从< 6.5增加到6.5-7.9，再增加到千分之8.0%，（分别为3.8、11.1和16.4%; p < 0.001）和重度（分别为0.9、2.5和4.3%; p < 0.001）低血糖进行性显著增加。ICU中低血糖事件的发生与院内死亡率之间的关系独立且显著地受到病前血糖控制的影响，如通过校正的比值比（OR）和院内死亡率的95%置信区间（CI）评估的：（1）中度低血糖：HbA 1c < 6.5、6.5-7.9、8.0%的患者OR值分别为0.54、0.82、0.33-2.05，95% CI为0.25-1.16; OR 3.42，95% CI 1.29-9.06;（2）重度低血糖：OR 1.50，95% CI 0.42-5.33; OR 1.59，95% CI 0.36-7.10; OR 23.46，95% CI 5.13-107.28（与病前血糖控制的相互作用，p = 0.009）。我们发现，更高的血糖水平入院前的ICU，更高的死亡率风险时，患者经历了低血糖症。结论：在重症患者中，慢性病前高血糖症增加低血糖症的风险和修改急性低血糖症和死亡率之间的关联。
Purpose: To study the impact of pre-morbid glycemic control on the association between acute hypoglycemia in intensive care unit (ICU) patients and subsequent hospital mortality in critically ill patients.Methods: We performed a multicenter, multinational, retrospective observational study of patients with available HbA1c levels within the 3-month period preceding ICU admission. We separated patients into three cohorts according to pre-admission HbA1c levels (< 6.5, 6.5-7.9, a parts per thousand yen8.0 %, respectively). Based on published data, we defined a glucose concentration of 40-69 mg/dL (2.2-3.8 mmol/L) as moderate hypoglycemia and < 40 mg/dL (< 2.2 mmol/L) as severe hypoglycemia. We applied logistic regression analysis to study the impact of pre-morbid glycemic control on the relationship between acute hypoglycemia and mortality.Results: A total of 3084 critically ill patients were enrolled in the study. Among these patients, with increasing HbA1c levels from < 6.5, to 6.5-7.9, and to a parts per thousand yen8.0 %, the incidence of both moderate (3.8, 11.1, and 16.4 %, respectively; p < 0.001) and severe (0.9, 2.5, and 4.3 %, respectively; p < 0.001) hypoglycemia progressively and significantly increased. The relationship between the occurrence of hypoglycemic episodes in the ICU and in-hospital mortality was independently and significantly affected by pre-morbid glucose control, as assessed by adjusted odds ratio (OR) and 95 % confidence interval (CI) for hospital mortality: (1) moderate hypoglycemia: in patients with < 6.5, 6.5-7.9, and a parts per thousand yen8.0 % of HbA1c level-OR 0.54, 95 % CI 0.25-1.16; OR 0.82, 95 % CI 0.33-2.05; OR 3.42, 95 % CI 1.29-9.06, respectively; (2) severe hypoglycemia: OR 1.50, 95 % CI 0.42-5.33; OR 1.59, 95 % CI 0.36-7.10; OR 23.46, 95 % CI 5.13-107.28, respectively (interaction with pre-morbid glucose control, p = 0.009). We found that the higher the glucose level before admission to the ICU, the higher the mortality risk when patients experienced hypoglycemia.Conclusions: In critically ill patients, chronic pre-morbid hyperglycemia increases the risk of hypoglycemia and modifies the association between acute hypoglycemia and mortality.