Usefulness of the plasma glucose concentration-to-HbA1c ratio in predicting clinical outcomes during acute illness with extreme hyperglycaemia
Usefulness of the plasma glucose concentration-to-HbA1c ratio in predicting clinical outcomes during acute illness with extreme hyperglycaemia
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DOI：
10.1016/j.diabet.2016.07.036
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发表时间：
2017-02-01
影响因子：
7.2
通讯作者：
Chen, H. -S.
中科院分区：
文献类型：
--
作者：
Su, Y. -W.;Hsu, C. -Y.;Chen, H. -S.
目标。 - 评估急性疾病期间血浆葡萄糖与糖化血红蛋白比率 (GAR) 与临床结果之间的相关性。方法。 - 这项回顾性观察队列研究纳入了 661 名于 2008 年 7 月 1 日至 2010 年 9 月 30 日期间到我院急诊科就诊且血浆葡萄糖浓度 > 500mg/dL 的患者。在初次到急诊科就诊时记录收缩压、心率、白细胞、中性粒细胞、红细胞比容、血尿素氮、血清肌酐、肝功能和血浆葡萄糖浓度。过去 6 个月的糖化血红蛋白数据来自我们医院的数据库。葡萄糖与 HbA(1c) 比率 (GAR) 的计算方法为血浆葡萄糖浓度除以糖化血红蛋白。结果。 - 死亡者的 GAR 显着高于幸存者（81.0 +/- 25.9 vs 67.6 +/- 25.0；P < 0.001）。 GAR 较高的患者存在 90 天死亡率较高的趋势（趋势对数秩检验 P < 0.0001）。在多变量 Cox 回归分析中，GAR 与 90 天死亡率显着相关（1 个标准差 [SD] 变化的风险比 [HR]：1.41，95% 置信区间 [CI]：1.22-1.63；P < 0.001），但与血浆葡萄糖无关（HR：0.89，95% CI：0.70-1.13；P=0.328）。 GAR 较高的患者入住重症监护病房 (ICU) 的比率和机械呼吸机的使用率也较高。结论。 - GAR 独立预测 90 天死亡率、入住 ICU 和机械通气的使用。对于血糖水平极高的患者来说，它比单独的血浆葡萄糖更能预测患者的结果。 2016 爱思唯尔马森公司。版权所有。
Aims. - To evaluate the correlation between the plasma glucose-to-glycated haemoglobin ratio (GAR) and clinical outcome during acute illness.Methods. - This retrospective observational cohort study enrolled 661 patients who visited the emergency department of our hospital between 1 July 2008 and 30 September 2010 with plasma glucose concentrations >500mg/dL. Systolic blood pressure, heart rate, white blood cells, neutrophils, haematocrit, blood urea nitrogen, serum creatinine, liver function and plasma glucose concentration were recorded at the initial presentation to the emergency department. Data on glycated haemoglobin over the preceding 6 months were reviewed from our hospital database. The glucose-to-HbA(1c) ratio (GAR) was calculated as the plasma glucose concentration divided by glycated haemoglobin.Results. - The GAR of those who died was significantly higher than that of the survivors (81.0 +/- 25.9 vs 67.6 +/- 25.0; P < 0.001). There was a trend towards a higher 90-day mortality rate in patients with higher GARs (log-rank test P < 0.0001 for trend). On multivariate Cox regression analysis, the GAR was significantly related to 90-day mortality (hazard ratio [HR] for 1 standard deviation [SD] change: 1.41, 95% confidence interval [CI]: 1.22-1.63; P < 0.001), but not to plasma glucose (HR: 0.89, 95% CI: 0.70-1.13; P=0.328). Rates of intensive care unit (ICU) admission and mechanical ventilator use were also higher in those with higher GARs.Conclusion. - GAR independently predicted 90-day mortality, ICU admission and use of mechanical ventilation. It was also a better predictor of patient outcomes than plasma glucose alone in patients with extremely high glucose levels. 2016 Elsevier Masson SAS. All rights reserved.