Variability of blood glucose concentration and short-term mortality in ctitically ill patients
Variability of blood glucose concentration and short-term mortality in ctitically ill patients
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DOI：
10.1097/00000542-200608000-00006
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发表时间：
2006-08-01
期刊：
影响因子：
8.8
通讯作者：
Hart, Graerne
中科院分区：
文献类型：
--
作者：
Egi, Moritoki;Bellomo, Rinaldo;Hart, Graerne
背景：强化胰岛素治疗可以降低选定手术患者的死亡率和发病率。强化胰岛素治疗也降低了血糖浓度的SD，这是一种公认的变异性测量方法。目前还没有关于葡萄糖浓度变异性的可能意义的信息。方法：这些方法包括从电子存储的生化数据库中提取血糖值和从电子存储的前瞻性收集的患者数据库中提取关于患者特征、临床特征和结果的数据;结果：在7，049例重症W患者的研究队列中，有168，337次血糖测量（平均4.2小时测量）。存活者血糖浓度的平均± SD为1.7 ± 1.3 mm，而非存活者为2.3 ± 1.6 mm（P <0.001）。多因素Logistic回归分析显示，血糖均值和标准差均与重症监护室死亡率显著相关（P <0.001;比值比[每1 mm]分别为1.23和1.27）和住院死亡率（P <0.001和P = 0.013;比值比[每1 mm]分别为1.21和1.18）。结论：血糖浓度的SD是重症监护病房和医院死亡率的重要独立预测因子。降低血糖浓度的变异性可能是血糖管理的一个重要方面。
Background: Intensive insulin therapy may reduce mortality and morbidity in selected surgical patients. intensive insulin therapy also reduced the SD of blood glucose concentration, an accepted measure of variability. There is no information on the possible significance of variability in glucose concentration.Methods: The methods included extraction of blood glucose values from electronically stored biochemical databases and of data on patient's characteristics, clinical features, and outcome from electronically stored prospectively collected patient databases; calculation of SD of glucose as a marker of variability and of several indices of glucose control in each patient; and statistical assessment of the relation between these variables and intensive care unit mortality.Results: There were 168,337 blood glucose measurements in the study cohort of 7,049 critically W patients (4.2 hourly measurements on average). The mean +/- SD of blood glucose concentration was 1.7 +/- 1.3 mm in survivors and 2.3 +/- 1.6 mm in nonsurvivors (P < 0.001). Using multiple variable logistic regression analysis, both mean and SD of blood glucose were significantly associated with intensive care unit mortality (P < 0.001; odds ratios [per 1 mm] 1.23 and 1.27, respectively) and hospital mortality (P < 0.001 and P = 0.013; odds ratios [per 1 mm] 1.21 and 1.18, respectively).Conclusions: The SD of glucose concentration is a significant independent predictor of intensive care unit and hospital mortality. Decreasing the variability of blood glucose concentration might be an important aspect of glucose management.