Hypoglycemia in sepsis: risk factors and clinical characteristics.
Hypoglycemia in sepsis: risk factors and clinical characteristics.
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脓毒症中的低血糖：危险因素和临床特征。
DOI：
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发表时间：
1997
影响因子：
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通讯作者：
C. Rattarasarn
中科院分区：
文献类型：
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作者：
C. Rattarasarn
为了确定败血症患者发生低血糖的危险因素和临床特征，对52例败血症期间出现自发性低血糖(血糖50 mg/dl)的患者和49例非糖尿病对照患者进行了病例对照研究，后者将脓毒症作为死亡的直接原因，但没有发生低血糖。评估两组患者是否有发生低血糖的潜在危险因素，包括饥饿状态、营养不良、肾功能不全、急、慢性肝病和恶性肿瘤，以及低血糖的临床特征。低血糖患者的最低血糖水平平均值为23.4+/-14.9(SD)mg/dl(范围3-47)。三分之一的患者从到达医院的时间起就被发现患有低血糖。约90%的患者在低血糖时有感染性休克。死亡率为90%；80%在第一次低血糖发作后48小时内死亡。在这些危险因素中，饥饿和肝病与低血糖的发生独立相关，其优势比分别为6.38(95%可信区间1.95~20.86；P=0.002)和3.59(95%可信区间1.09~11.81；P=0.035)。总之，脓毒症患者的低血糖与严重的预后有关。禁食超过24小时或在败血症时患有急性或慢性肝病的患者发生低血糖的风险显著增加。
To determine risk factors for the development and clinical characteristics of hypoglycemia in patients with sepsis, a case-control study was performed in 52 case-patients who developed spontaneous hypoglycemia (plasma glucose < 50 mg/dl) during episodes of sepsis compared with 49 nondiabetic, control-patients who had sepsis as an immediate cause of death and did not develop hypoglycemia. The presence or absence of potential risk factors for the development of hypoglycemia which consisted of the state of starvation, malnutrition, renal insufficiency, acute or chronic liver disease and malignancy were evaluated in both groups as well as the clinical characteristics of hypoglycemia. The mean of the lowest plasma glucose levels in hypoglycemic patients was 23.4 +/- 14.9 (SD) mg/dl (range 3-47). One-third of patients were found having hypoglycemia since the time of arrival to the hospital. About 90 per cent had septic shock at the time of hypoglycemia. The mortality rate was 90 per cent; 80 per cent died within 48 hours after the first episode of hypoglycemia. Among those risk factors, starvation and liver disease were independently associated with the development of hypoglycemia with odd ratios of 6.38 (95% confidence interval 1.95-20.86; P = 0.002), and 3.59 (95% confidence interval 1.09-11.81; P = 0.035), respectively. In conclusion, hypoglycemia in patients with sepsis was associated with a grave prognosis. The risk of developing hypoglycemia increased significantly in patients who had been fasted for more than 24 hours or had acute or chronic liver disease at the time of sepsis.