Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study.
Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study.
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DOI：
10.1007/s00592-021-01818-3
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发表时间：
2022-04
影响因子：
3.8
通讯作者：
Lv W
中科院分区：
文献类型：
--
作者：
Ma H;Yu G;Wang Z;Zhou P;Lv W
包括高血糖、低血糖和血糖变异性（GV）增加的三个领域的功能障碍与危重患者的高死亡率相关。然而，这种关联因糖尿病状态而异，这方面的报告有限。本研究的目的是评估糖尿病状态下危重患者的三个功能障碍领域与死亡率之间的相关性，并确定功能障碍的影响因素。这项回顾性研究纳入了958例重症患者（入住ICU），有或无DM。异常定义为三个维度中任何一个的异常。我们使用二元逻辑回归评估了血糖控制的三个领域对死亡率的影响，然后调整了混杂因素。使用累积Logistic回归分析研究精神障碍与其他变量之间的关联。在调整混杂因素后，GV独立且相似地影响两组的死亡率（DM：比值比[OR]，1.05; 95%置信区间[CI]：1.03 - 1.08; p <0.001;非DM：OR，1.07; 95% CI，1.03 - 1.11; p = 0.002）。在无糖尿病患者中，低血糖与ICU死亡率密切相关（3.12; 1.76 - 5.53; p <0.001），而在糖尿病患者中，低血糖与ICU死亡率的相关性较小（1.18; 0.49 - 2.83; p = 0.72）。高血压与两组的死亡率无显著相关性。然而，精神障碍的影响似乎是累积的。导致功能障碍的因素包括疾病严重程度、胰岛素治疗、糖皮质激素使用、血清白蛋白水平、全肠外营养、糖尿病持续时间、降钙素原水平升高以及需要机械通气和肾脏替代治疗。三个维度的功能障碍和死亡率之间的关联因糖尿病状态而异。危重患者的血糖异常与死亡率过高相关;然而，考虑到糖尿病状态和更广泛的维度，患者的血糖管理应针对患者的需求。所确定的代谢障碍因素可用于危重症患者血糖管理需求的风险评估，这可能会改善临床结局。
Dysglycemia, including the three domains hyperglycemia, hypoglycemia, and increased glycemic variability (GV), is associated with high mortality among critically ill patients. However, this association differs by diabetes status, and reports in this regard are limited. This study aimed to evaluate the associations between the three dysglycemia domains and mortality in critically ill patients by diabetes status and determined the contributing factors for dysglycemia. This retrospective study included 958 critically ill patients (admitted to the ICU) with or without DM. Dysglycemia was defined as abnormality of any of the three dimensions. We evaluated the effects of the three domains of glucose control on mortality using binary logistic regression and then adjusted for confounders. The associations between dysglycemia and other variables were investigated using cumulative logistic regression analysis. GV independently and similarly affected mortality in both groups after adjustment for confounders (DM: odds ratio [OR], 1.05; 95% confidence interval [CI]: 1.03-1.08; p <0.001; non-DM: OR, 1.07; 95% CI, 1.03-1.11; p = 0.002). Hypoglycemia was strongly associated with ICU mortality among patients without DM (3.12; 1.76-5.53; p <0.001) and less so among those with DM (1.18; 0.49-2.83; p = 0.72). Hyperglycemia was non-significantly associated with mortality in both groups. However, the effects of dysglycemia seemed cumulative. The factors contributing to dysglycemia included disease severity, insulin treatment, glucocorticoid use, serum albumin level, total parenteral nutrition, duration of diabetes, elevated procalcitonin level, and need for mechanical ventilation and renal replacement therapy. The association between the three dimensions of dysglycemia and mortality varied by diabetes status. Dysglycemia in critical patients is associated with excess mortality; however, glucose management in patients should be specific to the patient’s need considering the diabetes status and broader dimensions. The identified factors for dysglycemia could be used for risk assessment in glucose management requirement in critically ill patients, which may improve clinical outcomes.
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