Glycemic variability: A strong independent predictor of mortality in critically ill patients
Glycemic variability: A strong independent predictor of mortality in critically ill patients
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DOI：
10.1097/ccm.0b013e31818b38d2
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发表时间：
2008-11-01
影响因子：
8.8
通讯作者：
Krinsley, James S.
中科院分区：
文献类型：
--
作者：
Krinsley, James S.
目标。目的：通过每个患者平均血糖水平的标准差来评估血糖变异性对危重成人患者死亡率的影响。设计：对大量前瞻性评估的患者进行回顾。大学附属社区医院14个床位的内科外科成人重症监护病房。患者：1999年10月至2007年10月连续收治的3,252例患者，至少取3次静脉血糖。测量和主要结果：3252例患者的急性生理学和慢性健康状况评分(SO)平均为20.0(8.9)，病死率为24.4%，从平均血糖水平为70 mg/dL~99 mg/dL的患者的18.1%到平均血糖水平为180+mg/dL的患者的35.9%。在正常血糖范围内，血糖变异性与死亡率之间的关系最强。在平均血糖水平为70 mg/dL~99 mg/dL的410例患者中，死亡率为5.9%~30.1%；对于1031例平均血糖水平为100 mg/dL~119 mg/dL的患者，相应范围为9.7%~31.0%。在整个队列中，血糖变异性最低四分位数的患者死亡率为12.1%，第二、三、四分位数分别增加到19.9%、27.7%和37.8%。前四分位数的重症监护病房患者的住院时间比后三个四分位数的患者短(p<；.001)。这项研究表明，在这一不同类型的危重患者群体中，血糖变异性的增加具有很强的独立死亡风险。以前发表的关于血糖控制的干预性研究可以用血糖变异性的指标重新解释。确保低度血糖变异性的措施可能会改善重症监护病房实施血糖控制的结果。最后，正在进行的和未来的研究应考虑将这一新指标纳入他们的研究设计。(CRET CARE Med 2008；36：3008-3013)
Objectives. To determine the effect of glycemic variability, assessed by the standard deviation of each patient's mean glucose level, on mortality in a population of critically ill adult patients.Design: Retrospective review of a large cohort of prospectively evaluated patients.Setting. Fourteen-bed medical surgical adult intensive care unit of a university affiliated community hospital.Patients: Three thousand two hundred fifty-two patients consecutively admitted between October 1999 and October 2007 with at least three venous glucose samples.Interventions. None.Measurements and Main Results: The mean (So) Acute Physiology and Chronic Health Evaluation 11 score of the 3252 patients was 20.0 (8.9) and their mortality was 24.4%, ranging from 18.1% among patients with mean glucose level 70 mg/dL to 99 mg/dL to 35.9% among patients with mean glucose level 180+ mg/dL. The relationship between glycemic variability and mortality was strongest in the euglycemic range. For the 410 patients with mean glucose level 70 mg/dL to 99 mg/dL, mortality ranged from 5.9% in the first quartile of glycemic variability to 30.1% in the fourth; for the 1031 patients with mean glucose level 100 mg/dL to 119 mg/dL the corresponding range was 9.7% to 31.0%. Mortality among patients in the entire cohort with the lowest quartile of glycemic variability was 12.1%, increasing to 19.9%, 27.7%, and 37.8% in the second, third, and fourth quartiles. Intensive care unit length of stay was shorter among patients in the first quartile compared with those in the other three (p < .001).Conclusions. This study demonstrates that increasing glycemic variability conferred a strong independent risk of mortality in this heterogeneous population of critically ill patients. Previously published interventional studies of glycemic control may be reinterpreted using the metric of glycemic variability. Measures to ensure a low degree of glycemic variability may improve outcomes in intensive care unit's implementing glycemic control. Finally, ongoing and future investigations should consider including this new metric in their study design. (Crit Care Med 2008; 36:3008-3013)