Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis.
Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis.
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DOI：
10.1097/cce.0000000000000152
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发表时间：
2020-07-01
影响因子：
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通讯作者：
Rizzo, Stefano Giovanni
中科院分区：
文献类型：
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作者：
Fabbri, Andrea;Marchesini, Giulio;Rizzo, Stefano Giovanni
目的：血糖控制不佳与糖尿病重症患者的死亡率相关。本研究旨在评估应激性高血糖对因脓毒症入院的糖尿病患者的预测价值。
设计：回顾性观察研究。
地点：一家地区医院的成人急诊科和重症监护室。
患者：在对急诊科脓毒症相关住院情况进行的10年回顾性分析中，我们对915名糖尿病患者（男性占54.0%）进行了二次分析，这些患者入院时的空腹血糖和糖化血红蛋白数据均可得。
干预措施：无。
测量及主要结果：患者平均年龄为79.0岁（标准差11.0），入院时血糖为174.0毫克/分升（74.3毫克/分升），糖化血红蛋白为7.7%（1.7%）。应激性高血糖由应激性高血糖比率定义，即入院时空腹血糖浓度除以由糖化血红蛋白得出的估计平均血糖。共有305名患者（33.3%）在医院死亡。通过多变量逻辑模型对与住院病死率相关的因素进行了检验。在糖尿病患者中，确认了在普通人群中预测结局的10个变量（男性、年龄较大、器官功能障碍诊断数量，特别是心血管功能障碍、感染/寄生虫病、循环系统、呼吸系统、消化系统疾病诊断以及查尔森合并症指数）。此外，血糖控制（糖化血红蛋白：比值比，1.17；95%置信区间，1.15 - 1.40）和应激性高血糖（应激性高血糖比率：5.25；3.62 - 7.63）也是显著的病死率预测因素。高应激性高血糖比率（≥1.14）显著提高了判别能力（受试者工作特征曲线下面积，0.864；标准误，0.013；P < 0.001）。
结论：即使在糖尿病患者中，应激性高血糖也可预测脓毒症入院后的死亡率。应激性高血糖比率可用于优化对不良结局的预测。
OBJECTIVES: Poor glycemic control is associated with mortality in critical patients with diabetes. The aim of the study was to assess the predicting value of stress hyperglycemia in patients with diabetes following hospital admission for sepsis.DESIGN: Retrospective observational study.SETTING: Adult, emergency department, and critical care in a district hospital.PATIENTS: In a 10-year retrospective analysis of sepsis-related hospitalizations in the emergency department, we carried out a secondary analysis of 915 patients with diabetes (males, 54.0%) in whom both fasting glucose at entry and glycosylated hemoglobin were available.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Patients' mean age was 79.0 (sd 11.0), glucose at admission was 174.0 mg/dL (74.3 mg/dL), and glycosylated hemoglobin was 7.7% (1.7%). Stress hyperglycemia was defined by the stress hyperglycemia ratio, that is, fasting glucose concentration at admission divided by the estimated average glucose derived from glycosylated hemoglobin. A total of 305 patients died (33.3%) in hospital. Factors associated with in-hospital case fatality rate were tested by multivariable logistic model. Ten variables predicting outcomes in the general population were confirmed in the presence of diabetes (male sex, older age, number of organ dysfunction diagnoses, in particular cardiovascular dysfunction, infection/parasitic, circulatory, respiratory, digestive diseases diagnosis, and Charlson Comorbidity Index). In addition, also glycemic control (glycosylated hemoglobin: odds ratio, 1.17; 95% CI, 1.15-1.40) and stress hyperglycemia (stress hyperglycemia ratio: 5.25; 3.62-7.63) were significant case fatality rate predictors. High stress hyperglycemia ratio (≥ 1.14) significantly increased the discriminant capacity (area under the receiver operating characteristic curve, 0.864; se, 0.013; p < 0.001).CONCLUSIONS: Stress hyperglycemia, even in the presence of diabetes, is predictive of mortality following admission for sepsis. Stress hyperglycemia ratio may be used to refine prediction of an unfavorable outcome.