Glucose variability and mortality in patients with sepsis.
Glucose variability and mortality in patients with sepsis.
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DOI：
10.1097/ccm.0b013e3181810378
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发表时间：
2008-08
影响因子：
8.8
通讯作者：
Preiser JC
中科院分区：
文献类型：
--
作者：
Ali NA;O'Brien JM Jr;Dungan K;Phillips G;Marsh CB;Lemeshow S;Connors AF Jr;Preiser JC
对于脓毒症受试者，一直提倡治疗和预防高血糖症。葡萄糖变异性，而不是葡萄糖水平，也被证明是与住院死亡率相关的重要因素，一般来说，危重患者。我们的目的是确定脓毒症患者的血糖变异性和住院死亡率之间的关系，以及最能反映这种风险的血糖变异性的表达。回顾性、单中心队列研究。学术，三级护理医院。包括诊断为脓毒症的住院>1天的成人受试者。没有。所有受试者的血糖变异性计算为血糖的平均值和标准差、血糖波动的平均幅度和血糖不稳定指数。住院死亡率是主要结局变量。在校正重要的协变量后，使用Logistic回归确定与血糖变异性指标相关的住院死亡几率。在用于测量血糖变异性的方法中，血糖不稳定性指数对死亡率具有最好的区分力（曲线下面积= 0.67，p < 0.001）。在校正混杂因素（包括器官衰竭的数量和低血糖的发生）后，血糖不稳定指数和平均血糖水平以及住院死亡率之间存在显著的相互作用。在队列中平均血糖水平高于中位数的受试者中，较高的血糖不稳定指数与死亡率无关。然而，血糖不稳定指数升高但平均血糖值较低的受试者与血糖不稳定指数较低的受试者相比，住院死亡率的比值几乎增加了5倍（比值比= 4.73，95%置信区间= 2.6 - 8.7）。葡萄糖变异性与脓毒症患者的住院死亡率独立相关。应研究降低血糖变异性的策略，以确定它们是否能改善脓毒症患者的预后。
Treatment and prevention of hyperglycemia has been advocated for subjects with sepsis. Glucose variability, rather than the glucose level, has also been shown to be an important factor associated with in-hospital mortality, in general, critically ill patients. Our objective was to determine the association between glucose variability and hospital mortality in septic patients and the expression of glucose variability that best reflects this risk. Retrospective, single-center cohort study. Academic, tertiary care hospital. Adult subjects hospitalized for >1 day, with a diagnosis of sepsis were included. None. Glucose variability was calculated for all subjects as the average and standard deviation of glucose, the mean amplitude of glycemic excursions, and the glycemic lability index. Hospital mortality was the primary outcome variable. Logistic regression was used to determine the odds of hospital death in relation to measures of glucose variability after adjustment for important covariates. Of the methods used to measure glucose variability, the glycemic lability index had the best discrimination for mortality (area under the curve = 0.67, p < 0.001). After adjustment for confounders, including the number of organ failures and the occurrence of hypoglycemia, there was a significant interaction between glycemic lability index and average glucose level, and the odds of hospital mortality. Higher glycemic lability index was not independently associated with mortality among subjects with average glucose levels above the median for the cohort. However, subjects with increased glycemic lability index, but lower average glucose values had almost five-fold increased odds of hospital mortality (odds ratio = 4.73, 95% confidence interval = 2.6 – 8.7) compared with those with lower glycemic lability index. Glucose variability is independently associated with hospital mortality in septic patients. Strategies to reduce glucose variability should be studied to determine whether they improve the outcomes of septic patients.