Glycemic lability index and mortality in critically ill patients-A multicenter cohort study
Glycemic lability index and mortality in critically ill patients-A multicenter cohort study
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DOI：
10.1111/aas.13843
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发表时间：
2021-05-20
影响因子：
2.1
通讯作者：
Martensson, Johan
中科院分区：
文献类型：
--
作者：
Hanna, Michel;Balintescu, Anca;Martensson, Johan
背景新出现的证据表明重症监护病房（ICU）住院期间血糖变异性与死亡之间存在关系。我们评估了平均血糖、低血糖发生率或病前血糖控制是否改变了这种关系。方法在这项回顾性、多中心队列研究中，我们纳入了澳大利亚和瑞典五个ICU收治的成年患者，这些患者具有入院前可用的糖化血红蛋白A1 c（HbA 1c）和三个或更多血糖读数。我们计算了血糖不稳定指数（GLI），一种血糖变异性的测量方法，以及所有血糖读数的时间加权平均血糖（TWA-BG）。我们使用logistic回归分析，调整低血糖和入院特征，以评估GLI与高血糖的独立相关性。（高于vs.低于队列中位数）和TWA-BG结果在2305例患者中，859例（37%）患有糖尿病，中位GLI为40 [mmol/L]（2）/h/周，中位TWA-BG为8.2 mmol/L，171例（7%）发生低血糖，371例（16%）死亡。GLI高于与低于中位值的死亡校正比值比为1.61（95% CI，1.19-2.15; P = .002），TWA-BG高于与低于中位值的死亡校正比值比为1.06（95% CI，0.80-1.41; P = .67）。GLI和死亡率之间的关系不受TWA-BG（P [交互作用] = 0.66）、糖尿病史（P [交互作用] = 0.89）或HbA 1c ≥ 52 mmol/mol（vs.
Background Emerging evidence indicates a relationship between glycemic variability during intensive care unit (ICU) admission and death. We assessed whether mean glucose, hypoglycemia occurrence, or premorbid glycemic control modified this relationship.Methods In this retrospective, multicenter cohort study, we included adult patients admitted to five ICUs in Australia and Sweden with available preadmission glycated hemoglobin A1c (HbA1c) and three or more glucose readings. We calculated the glycemic lability index (GLI), a measure of glycemic variability, and the time-weighted average blood glucose (TWA-BG) from all glucose readings. We used logistic regression analysis with adjustment for hypoglycemia and admission characteristics to assess the independent association of GLI (above vs. below cohort median) and TWA-BG (above vs. below cohort median) with hospital mortality.Results Among 2305 patients, 859 (37%) had diabetes, median GLI was 40 [mmol/L](2)/h/week, median TWA-BG was 8.2 mmol/L, 171 (7%) developed hypoglycemia, and 371 (16%) died. The adjusted odds ratio for death was 1.61 (95% CI, 1.19-2.15; P = .002) for GLI above versus below median and 1.06 (95% CI, 0.80-1.41; P = .67) for TWA-BG above versus below median. The relationship between GLI and mortality was not modified by TWA-BG (P [interaction] = 0.66), a history of diabetes (P [interaction] = 0.89) or by HbA1c >= 52 mmol/mol (vs.