Hyperlactatemia affects the association of hyperglycemia with mortality in nondiabetic adults with sepsis.
Hyperlactatemia affects the association of hyperglycemia with mortality in nondiabetic adults with sepsis.
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DOI：
10.1111/acem.12015
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发表时间：
2012-11
期刊：
影响因子：
--
通讯作者：
Panacek EA
中科院分区：
文献类型：
--
作者：
Green JP;Berger T;Garg N;Horeczko T;Suarez A;Radeos MS;Hagar Y;Panacek EA
入院时高血糖已被报告为非糖尿病脓毒症患者的死亡风险因素;然而，这些分析中未涉及高血糖与高乳酸血症的已知相关性。目的是确定在校正并发高乳酸血症后，高血糖与死亡率的相关性是否仍然显著。这是一项在单中心进行的回顾性队列研究的事后嵌套分析。提供者在艾德就诊期间确定了研究受试者;所有数据均从电子病历（EMR）中收集。非糖尿病成人艾德患者因疑似感染住院，两个或两个以上全身炎症反应综合征（SIRS）标准，并在艾德同时乳酸和葡萄糖测试。研究背景是2007年至2009年一家城市教学医院的艾德。为了评价高血糖症（葡萄糖> 200 mg/dL）与高乳酸血症（乳酸≥ 4.0 mmol/L）的相关性，建立了logistic回归模型。结果诊断为高乳酸血症，主要关注变量为高血糖。建立第二个模型以确定共存的高乳酸血症是否影响高血糖症与死亡率的相关性;主要结局是28天死亡率，主要风险变量是高血糖症与同时性高乳酸血症的相互作用项。两种模型均根据人口统计学、合并症、当前感染源和肾、呼吸、血液或心血管功能障碍的客观证据进行调整。共纳入1，236例艾德患者，中位年龄为77岁（四分位距[IQR] = 60 - 87岁）。共有115例（9.3%）受试者发生高血糖，162例（13%）发生高乳酸血症，214例（17%）在初次艾德访视后28天内死亡。校正后，高血糖与同时性高乳酸血症显著相关（比值比[OR] = 4.14，95%置信区间[CI] = 2.65 - 6.45）。高血糖症和并发高乳酸血症与死亡风险增加相关（OR = 3.96，95%CI = 2.01至7.79），但在没有并发高乳酸血症的情况下，高血糖症与死亡风险增加无关（OR = 0.78，95%CI = 0.39至1.57）。在这一队列的非糖尿病成人脓毒症患者中，死亡风险并不随高血糖而增加，除非同时伴有高乳酸血症。先前报道的高血糖与非糖尿病性脓毒症死亡率的相关性可能是由于高血糖与高乳酸血症的相关性。
Admission hyperglycemia has been reported as a mortality risk factor for septic nondiabetic patients; however, hyperglycemia’s known association with hyperlactatemia was not addressed in these analyses. The objective was to determine whether the association of hyperglycemia with mortality remains significant when adjusted for concurrent hyperlactatemia. This was a post hoc, nested analysis of a retrospective cohort study performed at a single center. Providers had identified study subjects during their ED encounters; all data were collected from the electronic medical record (EMR). Nondiabetic adult ED patients hospitalized for suspected infection, two or more systemic inflammatory response syndrome (SIRS) criteria, and simultaneous lactate and glucose testing in the ED were enrolled. The setting was the ED of an urban teaching hospital from 2007 to 2009. To evaluate the association of hyperglycemia (glucose > 200 mg/dL) with hyperlactatemia (lactate ≥ 4.0 mmol/L), a logistic regression model was created. The outcome was a diagnosis of hyperlactatemia, and the primary variable of interest was hyperglycemia. A second model was created to determine if coexisting hyperlactatemia affects hyperglycemia’s association with mortality; the main outcome was 28-day mortality, and the primary risk variable was hyperglycemia with an interaction term for simultaneous hyperlactatemia. Both models were adjusted for demographics; comorbidities; presenting infectious source; and objective evidence of renal, respiratory, hematologic, or cardiovascular dysfunction. A total of 1,236 ED patients were included, and the median age was 77 years (interquartile range [IQR] = 60 to 87 years). A total of 115 (9.3%) subjects were hyperglycemic, 162 (13%) were hyperlactatemic, and 214 (17%) died within 28 days of their initial ED visits. After adjustment, hyperglycemia was significantly associated with simultaneous hyperlactatemia (odds ratio [OR] = 4.14, 95% confidence interval [CI] = 2.65 to 6.45). Hyperglycemia and concurrent hyperlactatemia were associated with increased mortality risk (OR = 3.96, 95% CI = 2.01 to 7.79), but hyperglycemia in the absence of simultaneous hyperlactatemia was not (OR = 0.78, 95% CI = 0.39 to 1.57). In this cohort of septic adult nondiabetic patients, mortality risk did not increase with hyperglycemia unless associated with simultaneous hyperlactatemia. The previously reported association of hyperglycemia with mortality in nondiabetic sepsis may be due to the association of hyperglycemia with hyperlactatemia.
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