中重度胸腹损伤患者入院高血糖的死亡率高于非糖尿病正常血糖患者。
Higher Mortality Rate in Moderate-to-Severe Thoracoabdominal Injury Patients with Admission Hyperglycemia Than Nondiabetic Normoglycemic Patients.
机构信息
Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan.
Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan.
出版信息
Int J Environ Res Public Health. 2019 Sep 25;16(19):3562. doi: 10.3390/ijerph16193562.
BACKGROUND
Hyperglycemia at admission is associated with an increase in worse outcomes in trauma patients. However, admission hyperglycemia is not only due to diabetic hyperglycemia (DH), but also stress-induced hyperglycemia (SIH). This study was designed to evaluate the mortality rates between adult moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia as DH or SIH and in patients with nondiabetic normoglycemia (NDN) at a level 1 trauma center.
METHODS
Patients with a glucose level ≥200 mg/dL upon arrival at the hospital emergency department were diagnosed with admission hyperglycemia. Diabetes mellitus (DM) was diagnosed when patients had an admission glycohemoglobin A1c ≥6.5% or had a past history of DM. Admission hyperglycemia related to DH and SIH was diagnosed in patients with and without DM. Patients who had a thoracoabdominal Abbreviated Injury Scale score <3, a polytrauma, a burn injury and were below 20 years of age were excluded. A total of 52 patients with SIH, 79 patients with DH, and 621 patients with NDN were included from the registered trauma database between 1 January 2009, and 31 December 2018. To reduce the confounding effects of sex, age, comorbidities, and injury severity of patients in assessing the mortality rate, different 1:1 propensity score-matched patient populations were established to assess the impact of admission hyperglycemia (SIH or DH) vs. NDN, as well as SIH vs. DH, on the outcomes.
RESULTS
DH was significantly more frequent in older patients (61.4 ± 13.7 vs. 49.8 ± 17.2 years, < 0.001) and in patients with higher incidences of preexisting hypertension (2.5% vs. 0.3%, < 0.001) and congestive heart failure (3.8% vs. 1.9%, = 0.014) than NDN. On the contrary, SIH had a higher injury severity score (median [Q1-Q3], 20 [15-22] vs. 13 [10-18], < 0.001) than DH. In matched patient populations, patients with either SIH or DH had a significantly higher mortality rate than NDN patients (10.6% vs. 0.0%, = 0.022, and 5.3% vs. 0.0%, = 0.043, respectively). However, the mortality rate was insignificantly different between SIH and DH (11.4% vs. 8.6%, odds ratio, 1.4; 95% confidence interval, 0.29-6.66; = 0.690).
CONCLUSION
This study revealed that admission hyperglycemia in the patients with thoracoabdominal injuries had a higher mortality rate than NDN patients with or without adjusting the differences in patient's age, sex, comorbidities, and injury severity.
背景
入院时的高血糖与创伤患者的预后恶化有关。然而，入院时的高血糖不仅是由于糖尿病性高血糖（DH），而且还与应激性高血糖（SIH）有关。本研究旨在评估在一级创伤中心，患有中度至重度胸腹损伤且入院时伴有高血糖的成人患者中，DH 或 SIH 患者与非糖尿病性正常血糖（NDN）患者的死亡率。
方法
入院时血糖水平≥200mg/dL 的患者被诊断为入院时高血糖。当患者入院时糖化血红蛋白 A1c≥6.5%或有糖尿病史时，诊断为糖尿病（DM）。在有或没有 DM 的患者中诊断与 DH 和 SIH 相关的入院时高血糖。排除胸腹损伤严重程度评分<3、多发伤、烧伤且年龄<20 岁的患者。从 2009 年 1 月 1 日至 2018 年 12 月 31 日，从注册创伤数据库中纳入了 52 例 SIH、79 例 DH 和 621 例 NDN 患者。为了减少患者性别、年龄、合并症和损伤严重程度对评估死亡率的混杂影响，建立了不同的 1:1 倾向评分匹配患者人群，以评估入院时高血糖（SIH 或 DH）与 NDN 以及 SIH 与 DH 对结局的影响。
结果
DH 患者年龄较大（61.4±13.7岁 vs. 49.8±17.2 岁，<0.001），且合并高血压（2.5% vs. 0.3%，<0.001）和充血性心力衰竭（3.8% vs. 1.9%，=0.014）的发生率高于 NDN 患者。相反，SIH 的损伤严重程度评分较高（中位数[Q1-Q3]，20[15-22] vs. 13[10-18]，<0.001）。在匹配的患者人群中，与 NDN 患者相比，无论 SIH 还是 DH 患者的死亡率均显著升高（10.6% vs. 0.0%，=0.022，5.3% vs. 0.0%，=0.043）。然而，SIH 和 DH 之间的死亡率差异无统计学意义（11.4% vs. 8.6%，比值比，1.4；95%置信区间，0.29-6.66；=0.690）。
结论
本研究表明，伴有胸腹损伤的患者入院时发生高血糖的死亡率高于伴有或不伴有患者年龄、性别、合并症和损伤严重程度差异的 NDN 患者。
Zotero 插件