Blood glucose concentration and outcome of critical illness: The impact of diabetes
Blood glucose concentration and outcome of critical illness: The impact of diabetes
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DOI：
10.1097/ccm.0b013e318181039a
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发表时间：
2008-08-01
影响因子：
8.8
通讯作者：
Bailey, Michael
中科院分区：
文献类型：
--
作者：
Egi, Moritoki;Bellomo, Rinaldo;Bailey, Michael
Objective.目的探讨糖尿病对危重病患者预后的影响。回顾性观察研究。两家大学医院的重症监护室。患者。队列研究4946例重症患者，包括728例糖尿病患者。干预：无。测量和主要结果：我们评估并比较了糖尿病和非糖尿病患者重症监护病房住院期间的死亡率之间的关系。共进行了125，036次血糖测量（平均每天5.7次测量）。重症监护室死亡率在非糖尿病患者中随平均血糖浓度的增加而显著增加，但在糖尿病患者中则不显著。时间加权血糖浓度（Glu（Tw））在8.0 - 10.0 mmol/L之间的非糖尿病患者在重症监护室死亡的可能性是相同范围内糖尿病患者的1.74倍（比值比= 1.74 [1.13-2.68] p = 0.01）。当Glu（tw）在10.0和11.1 mmol/L之间时，他们在重症监护室死亡的可能性也是糖尿病患者的三倍多（比值比= 3.34 [1.35-8.23] p = 0.009）。多因素Logistic回归分析显示，高血糖与非糖尿病患者的预后密切相关（p < 0.001），但与糖尿病患者的预后无显著相关性。结论：与非糖尿病患者不同，糖尿病患者在重症监护病房期间的高血糖与死亡率之间无明显相关性，在所有高血糖水平下死亡的优势比均显著降低。这些发现表明，在糖尿病危重患者中，高血糖可能具有不同的生物学和/或临床意义。
Objective. To study the impact of diabetes mellitus on the relationship between glycemia and mortality in critically ill patients.Design. Retrospective observational study.Setting. Intensive care units of two university hospitals.Patients. Cohort of 4946 critically ill patients including 728 patients with diabetes mellitus.Intervention: None.Measurements and Main Results: We assessed and compared the relationship between glycemia during intensive care unit stay and mortality in diabetic and nondiabetic patients. There were 125,036 blood glucose measurements (5.7 measurements/day on average). Intensive care unit mortality increased significantly with increasing mean blood glucose concentration in nondiabetes mellitus patients but not in diabetes mellitus patients. Nondiabetes mellitus patients with a time-weighted glucose concentration (Glu(Tw)) between 8.0 and 10.0 mmol/L were found to be 1.74 times more likely to die in intensive care unit as diabetes mellitus patients in the same range (odds ratio = 1.74 [1.13-2.68] p = 0.01). They were also more than three times more likely to die in the intensive care unit compared with diabetes mellitus patients when the Glu(tw) was between 10.0 and 11.1 mmol/L (odds ratio = 3.34 [1.35-8.23] p = 0.009). Using multivariate logistic regression analysis, hyperglycemia was strongly and independently associated with outcome in nondiabetic patients (p < 0.001) but showed no significant association with outcome in diabetic patients.Conclusions: Unlike nondiabetic patients, diabetic patients show no clear association between hyperglycemia during intensive care unit stay and mortality and markedly lower odds ratios of death at all levels of hyperglycemia. These findings suggest that, in critically patients with diabetes mellitus, hyperglycemia may have different biological and/or clinical implications.