Role of Diabetes in the Development of Acute Respiratory Distress Syndrome
Role of Diabetes in the Development of Acute Respiratory Distress Syndrome
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DOI：
10.1097/ccm.0b013e318298a2eb
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发表时间：
2013-12-01
影响因子：
8.8
通讯作者：
Gong, Michelle Ng
中科院分区：
文献类型：
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作者：
Yu, Shun;Christiani, David C.;Gong, Michelle Ng
目的：在一些（但不是全部）先前的研究中，糖尿病与急性呼吸窘迫综合征的发展减少有关。因此，我们研究了糖尿病与急性呼吸窘迫综合征发生之间的关系，以及这种关联是否会因糖尿病类型、急性呼吸窘迫综合征病因、糖尿病药物或其他潜在混杂因素而改变。设计：观察性前瞻性多中心研究。设置：两个三级学术医疗中心的四个成人 ICU。患者：三千八百六十名因脓毒症、肺炎、创伤、误吸或大量输血而面临急性呼吸窘迫综合征风险的危重患者。干预措施：无。测量和主要结果：25.8% 的患者有糖尿病史。单变量（比值比，0.79；95% CI，0.66-0.94）和多变量分析（调整后比值比，0.76；95% CI，0.61-0.95）糖尿病与急性呼吸窘迫综合征发生率较低相关。将糖尿病药物纳入模型后，糖尿病仍具有保护性（调整后的比值比，0.75；95% CI，0.59-0.94）。在脓毒症患者（调整后的比值比，0.77；95% CI，0.61-0.97）和非感染性病因患者（调整后的比值比，0.30；95% CI，0.10-0.90）亚组中，糖尿病与急性呼吸窘迫综合征的发生率降低相关。糖尿病对急性呼吸窘迫综合征发展的保护作用并不明确限于 1 型（调整后的比值比，0.50；95% CI，0.26-0.99；p = 0.046）或 2 型（调整后的比值比，0.77；95% CI，0.60-1.00；p = 0.050）糖尿病。在发生急性呼吸窘迫综合征的患者中，单变量（比值比，1.11；95% CI，0.80-1.52）或多变量分析（调整比值比，0.81；95% CI，0.56-1.18）糖尿病与 60 天死亡率无关。结论：糖尿病与急性呼吸窘迫综合征发生率较低相关，并且在调整糖尿病患者和非糖尿病患者之间的临床差异，例如肥胖、急性高血糖和糖尿病相关药物。此外，1 型和 2 型糖尿病患者以及所有高危患者亚组中也存在这种关联。
Objectives: Diabetes has been associated with decreased development of acute respiratory distress syndrome in some, but not all, previous studies. Therefore, we examined the relationship between diabetes and development of acute respiratory distress syndrome and whether this association was modified by type of diabetes, etiology of acute respiratory distress syndrome, diabetes medications, or other potential confounders.Design: Observational prospective multicenter study.Setting: Four adult ICUs at two tertiary academic medical centers.Patients: Three thousand eight hundred sixty critically ill patients at risk for acute respiratory distress syndrome from sepsis, pneumonia, trauma, aspiration, or massive transfusion.Interventions: None.Measurements and Main Results: Diabetes history was present in 25.8% of patients. Diabetes was associated with lower rates of developing acute respiratory distress syndrome on univariate (odds ratio, 0.79; 95% CI, 0.66-0.94) and multivariate analysis (adjusted odds ratio, 0.76; 95% CI, 0.61-0.95). After including diabetes medications into the model, diabetes remained protective (adjusted odds ratio, 0.75; 95% CI, 0.59-0.94). Diabetes was associated with decreased development of acute respiratory distress syndrome both in the subgroup of patients with sepsis (adjusted odds ratio, 0.77; 95% CI, 0.61-0.97) and patients with noninfectious etiologies (adjusted odds ratio, 0.30; 95% CI, 0.10-0.90). The protective effect of diabetes on acute respiratory distress syndrome development is not clearly restricted to either type 1 (adjusted odds ratio, 0.50; 95% CI, 0.26-0.99; p = 0.046) or type 2 (adjusted odds ratio, 0.77; 95% CI, 0.60-1.00; p = 0.050) diabetes. Among patients in whom acute respiratory distress syndrome developed, diabetes was not associated with 60-day mortality on univariate (odds ratio, 1.11; 95% CI, 0.80-1.52) or multivariate analysis (adjusted odds ratio, 0.81; 95% CI, 0.56-1.18).Conclusions: Diabetes is associated with a lower rate of acute respiratory distress syndrome development, and this relationship remained after adjusting for clinical differences between diabetics and nondiabetics, such as obesity, acute hyperglycemia, and diabetes-associated medications. In addition, this association was present for type 1 and 2 diabetics and in all subgroups of at-risk patients.