The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes
The interaction of chronic and acute glycemia with mortality in critically ill patients with diabetes
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DOI：
10.1097/ccm.0b013e3181feb5ea
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发表时间：
2011-01-01
影响因子：
8.8
通讯作者：
Bailey, Michael
中科院分区：
文献类型：
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作者：
Egi, Moritoki;Bellomo, Rinaldo;Bailey, Michael
目的：高血糖和死亡率之间的关系因糖尿病的存在而改变。对预先存在的高血糖的生物调节可能解释这种现象。我们测试了糖尿病患者危重病期间预先存在的高血糖程度是否会调节HbA 1c与预后之间的关联。设计：回顾性观察性研究。设置：两个三级重症监护病房。患者：415名重症糖尿病患者，在重症监护病房入院后3个月内测量HbA 1c水平。干预措施：无。测量和主要结果：该研究队列中有9，946次血糖测量（每天测量6.7次血糖;平均每3.6小时测量一次）。入院前HbA 1c水平中位数为7.0%。存活者和非存活者之间的HbA 1c水平（p = 0.17）或血糖浓度的时间加权平均值（p = 0.49）没有显著差异。当HbA 1c> 6.8%时，死亡者在重症监护室期间的血糖浓度时间加权平均值低于存活者。在多变量分析中，我们发现HbA 1c和时间加权血糖水平之间存在显著的相互作用，表明HbA 1c和死亡率之间的关系根据血糖浓度的时间加权平均值水平而变化（p = 0.008）。因此，在入院前HbA 1c水平较高（>7%）的患者中，与HbA 1c水平较低的队列相比，重症监护病房住院期间的时间加权急性血糖浓度越高（>10 mmol/L），住院死亡率越低（
Objectives: The relationship between hyperglycemia and mortality is altered by the presence of diabetes mellitus. Biological adjustment to preexisting hyperglycemia might explain this phenomenon. We tested whether the degree of preexisting hyperglycemia would modulate the association between glycemia and outcome during critical illness in patients with diabetes mellitus.Design: Retrospective observational study.Setting: Two tertiary intensive care units.Patients: Four hundred fifteen critically ill diabetic patients with HbA1c levels measured within 3 months of intensive care unit admission.Interventions: None.Measurements and Main Results: There were 9,946 blood glucose measurements in this study cohort (glucose measured 6.7 times per day; every 3.6 hrs on average). The median preadmission HbA1c level was 7.0%. There was no significant difference in HbA1c levels (p = .17) or time-weighted average of blood glucose concentrations (p = .49) between survivors and nonsurvivors. The time-weighted average of blood glucose concentrations during intensive care unit stay for nonsurvivors was lower than that of survivors when the HbA1c was >6.8%. In multivariate analysis, we found that there was a significant interaction between HbA1c and the time-weighted glucose level, indicating that the relationship between HbA1c and mortality changed according to the levels of time-weighted average of blood glucose concentrations (p = .008). As a consequence, in patients with higher (>7%) preadmission levels of HbA1c, the higher the time-weighted acute glucose concentration during intensive care unit stay (>10 mmol/L), the lower the hospital mortality compared with the lower HbA1c cohort (