Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults

Objective Aggressive glycemic control improves mortality and morbidity in critically ill adults, however implementation of such a strategy can be logistically difficult. This study evaluates the efficiency and safety of a nurse-managed insulin protocol in critically ill adults.Design Combined retrospective-prospective before-after cohort study.Setting Twenty-one bed, medical/surgical ICU in a tertiary care hospital.Patients Two cohorts of 50 consecutive ICU patients requiring insulin infusions.Intervention Patients in the control cohort received insulin infusions titrated according to target blood glucose ranges and sliding scales at the physicians discretion. Patients in the interventional cohort received an insulin infusion adjusted using a standardized protocol targeting a blood glucose of 4.5–6.1 mmol/l (81–110 mg/dl).Measurements and main results Efficiency was measured by comparing the time to reach, and the time spent within, the target range between cohorts. Safety was assessed by comparing the incidence of severe hypoglycemia, the frequency of rescue dextrose administration and the cumulative time that the infusion was held for hypoglycemia between cohorts. Patients in the interventional cohort reached their target more rapidly (11.3±7.9 vs 16.4±12.6 h; p=0.028) and maintained their blood glucose within the target range longer (11.5±3.7 vs 7.1±5.0 h/day; p<0.001) than controls. The standardized protocol yielded a four-fold reduction in the incidence of severe hypoglycemia (4 vs 16%; p=0.046) and reduced the median frequency of dextrose rescue therapy (0 [0–0.91] vs 0.17 [0–1.2] episodes/patient per day; p=0.01) as compared to controls.Conclusion Standardization of intensive insulin therapy improves the efficiency and safety of glycemic control in critically ill adults.     

Hyperactive delirium and blood glucose control in critically ill patients

Delirium is a common complication of critically ill patients and is often associated with metabolic disorders. One of the most frequent metabolic disorders in intensive care unit (ICU) patients is hyperglycaemia. The aim of this retrospective study of 196 adult ICU patients was to determine if there is an association between hyperactive delirium and blood glucose levels in ICU patients. Hyperactive delirium was diagnosed using the delirium detection score. Blood glucose levels were monitored by blood gas analysis every 4 h. Hyperactive delirium was detected in 55 (28%) patients. Delirious patients showed significantly higher blood glucose levels than non-delirious patients Higher overall complication rates, length of ventilation, ICU stay and mortality rates were seen in the delirium group. In a multivariate analysis, glucose level, alcohol abuse, APACHE II score, complication by hospital-acquired pneumonia and a diagnosis of polytrauma on-admission all significantly influenced the appearance of delirium.     

Computer-assisted glucose control in critically ill patients

OBJECTIVE: Intensive insulin therapy is associated with the risk of hypoglycemia and increased costs of material and personnel. We therefore evaluated the safety and efficiency of a computer-assisted glucose control protocol in a large population of critically ill patients. DESIGN AND SETTING: Observational cohort study in three intensive care units (32 beds) in a 1,300-bed university teaching hospital. PATIENTS: All 2,800 patients admitted to the surgical, neurosurgical, and cardiothoracic units; the study period started at each ICU after implementation of Glucose Regulation for Intensive Care Patients (GRIP), a freely available computer-assisted glucose control protocol. MEASUREMENTS AND RESULTS: We analysed compliance in relation to recommended insulin pump rates and glucose measurement frequency. Patients were on GRIP-ordered pump rates 97% of time. Median measurement time was 5[Symbol: see text]min late (IQR 20[Symbol: see text]min early to 34[Symbol: see text]min late). Hypoglycemia was uncommon (7% of patients for mild hypoglycemia, <[Symbol: see text]3.5[Symbol: see text]mmol/l; 0.86% for severe hypoglycemia, <[Symbol: see text]2.2[Symbol: see text]mmol/l). Our predefined target range (4.0-7.5[Symbol: see text]mmol/l) was reached after a median of 5.6[Symbol: see text]h (IQR 0.2-11.8) and maintained for 89% (70-100%) of the remaining stay at the ICU. The number of measurements needed was 5.9 (4.8-7.3) per patient per day. In-hospital mortality was 10.1%. CONCLUSIONS: Our computer-assisted glucose control protocol provides safe and efficient glucose regulation in routine intensive care practice. A low rate of hypoglycemic episodes was achieved with a considerably lower number of glucose measurements than used in most other schemes.     

Circadian rhythm of blood glucose values in critically ill patients

OBJECTIVE: To test whether there is a circadian rhythm of blood glucose control in critically ill patients and whether morning blood glucose is an accurate surrogate of overall blood glucose control. DESIGN: Retrospective multiple-center observational study. SETTING: Intensive care units of three tertiary hospitals and one affiliated private hospital. PATIENTS: Cohort of 8,307 consecutive critically ill patients. INTERVENTIONS: Extraction of blood glucose values from electronically stored measurements. Extraction of demographic and outcome data from unit and hospital databases. Statistical assessment of variations in blood glucose control over each 24-hr cycle. MEASUREMENTS AND MAIN RESULTS: We studied 208,362 blood glucose measurements in 8,307 patients (5.5 measurements/day/person). In each hospital, there was a circadian rhythm of blood glucose control (p<.0001). The differences between highest and lowest blood glucose concentration in different time periods in each hospital were 0.27, 0.28, 0.95, and 0.22 mmol/L. There was also significant variation in the incidence and notional duration of hyperglycemia. The differences between the lowest and highest incidence of hyperglycemia in different time periods were 3.3, 2.7, 9.9, and 2.6% in each hospital. In all four hospitals, the average blood glucose value from 5:30 am to 6:30 am was significantly lower than the 24-hr average. CONCLUSIONS: Blood glucose values and the incidence of hyperglycemia have a circadian rhythm in critically ill patients. Morning blood glucose may not be an accurate surrogate of blood glucose control over the daily cycle.     

Intensive insulin treatment improves forearm blood flow in critically ill patients: a randomized parallel design clinical trial

Introduction  

Intensive insulin treatment of critically ill patients was seen as a promising method of treatment, though recent studies showed that reducing the blood glucose level below 6 mmol/l had a detrimental outcome. The mechanisms of the effects of insulin in the critically ill are not completely understood. The purpose of the study was to test the hypothesis that intensive insulin treatment may influence forearm blood flow independently of global hemodynamic indicators.     

Managing blood glucose in critically ill patients with or without diabetes

Relationships between blood glucose concentration and outcome and also the optimum management of blood glucose remain highly contentious issues for critical care practitioners. Among the many controversies is whether critically ill patients with diabetes should be treated differently from those without diabetes. Krinsley and colleagues assembled a large observational database that sheds further light on the relationships of hyperglycemia, hypoglycemia and glucose variability and risk of death in critically ill patients with and without diabetes. Defining the optimum treatment and whether this should differ by diabetic status requires high-quality primary interventional research.The best management of stress-induced hyperglycemia in critically ill patients remains unknown and among the many controversies is whether patients with diabetes should be managed differently from those without diabetes. In a recent edition of Critical Care, Krinsley and colleagues report on associations between the ''three domains of glycemic control'' (hyperglycemia, hypoglycemia and glucose variability) in patients with or without a diagnosis of diabetes [1]. They assembled and analyzed a large database containing data from patients admitted to 23 ICUs in nine countries. Their purpose was to determine how diabetic status affected the relationships between glycemic control and outcome.Krinsley and colleagues report some interesting findings. For critically ill patients in general, the relationship between mean blood glucose concentration [BG] and outcome is known to be U-shaped, with increased mortality observed with both high and low mean [BG] [2]. When examining those patients with and without diabetes separately, Krinsley and colleagues report that the nadir of the U-shaped curve (the [BG] associated with lowest mortality) occurs at a different [BG] in those with diabetes. In patients with diabetes, an associated increase in mortality does not occur until a higher [BG]. Moderate and severe hypoglycemia (defined as minimum [BG] 40 to 69 mg/dl (2.2 to 3.8 mmol/l) and <40 mg/dl (<2.2 mmol/l), respectively) were associated with increased mortality regardless of diabetic status, whereas increased [BG] variability defined by the coefficient of variation was only associated with increased risk of death in patients without diabetes.How should we interpret these findings? Do they contradict or support what we already know about patients with diabetes admitted to ICUs, and should these results influence how we treat patients with diabetes?Firstly, we should recognize both the strengths and the weaknesses of the study. The strength of the study is mainly its size and that the authors drew data from different ICUs in different countries. The weaknesses are the observational nature of the study, which limits the inferences that can be drawn, and the lack of data on the actual management of [BG]. Additionally, the authors did not have access to measures of glycemic control prior to admission to the ICU and so their presumption that patients with diabetes may behave differently due to adaptive mechanisms developed owing to chronic hyperglycemia is based on supposition rather than on objective measurements such as glycosylated hemoglobin.What do we already know about patients with diabetes treated in ICUs? Patients with known diabetes have typically constituted around 15 to 20% of patients enrolled in trials of intensive versus conventional glucose control in the ICU [3,4], and perhaps around 19% of patients admitted to ICUs overall [5]. With the notable exception of patients undergoing cardiac surgery, a diagnosis of diabetes is not associated with an increased risk of death following admission to the ICU [5]. The reasons for this somewhat surprising finding have been discussed, including that patients with diabetes may be receiving medications that increase their chances of surviving critical illness [6]. An alternative explanation is that the apparent protective effect of diabetes is due to other confounding influences - for example, less sick patients with diabetes being admitted to the ICU because they are incorrectly perceived to be at increased risk of death. Data from randomized trials also confirm that patients with diabetes do not benefit from being treated with insulin with the goal of achieving normoglycemia [3,4], although whether they differ from patients without diabetes in this regard remains unclear and cannot be determined using observational data.While researchers have studied the effects of different blood glucose targets on the long-term outcomes of ambulant patients with diabetes [7], there has been no study specifically examining the effects of different blood glucose targets in critically ill patients with diabetes. As the optimum [BG] target for critically ill patients overall is not known, it would be vastly premature to call for future studies to be limited to patients with diabetes. This question can be addressed in an appropriately designed study recruiting ICU all-comers as long as patients with type I and type II diabetes are identified at baseline. Stratifying randomization by a diagnosis of diabetes would further increase the robustness of the results.In conclusion, Krinsley and colleagues report that the associations between [BG] and outcome are different in patients with and without diabetes although appropriate targets for management of blood glucose concentration can only be defined by future randomized trials. Such trials can and should be designed to determine whether treatment effects differ in patients who do or do not have diabetes at the time of enrolment.     

Accuracy of bedside capillary blood glucose measurements in critically ill patients

OBJECTIVE: To compare the accuracy of fingerstick with laboratory venous plasma glucose measurements (laboratory glucose) in medical ICU patients and to determine the factors which interfere with the accuracy of fingerstick measurements. PARTICIPANTS: The study included 80 consecutive patients aged 58+/-7 years, BMI 29.5+/-9.0, and APACHE II score 15+/-6 (277 simultaneous paired measurements). MEASUREMENTS: This prospective observational study compared fingerstick measurements to simultaneously sampled laboratory glucose once a day in patients in our medical ICU (twice daily if on an insulin infusion). Data recorded included patient demographics, admission diagnoses, APACHE II score, BMI, daily hematocrit, arterial blood gasses, chemistry results, concomitant medications (including vasopressors and corticosteroids), and upper extremity edema. Accuracy was defined as the percentage of paired values not in accord (>15 mg dl(-1)/ 0.83 mmol(-1)l(-1) difference for laboratory values <75 mg dl(-1)/4.12 mmol(-1)l(-1) and >20% difference for laboratory values >or=75 mg/dl). Outliers (blood glucose difference >100 mg dl(-1)/5.56 mmol(-1) l(-1)) were excluded from the correlation and distribution analyses. RESULTS: Mean fingerstick glucose was 129+/-45 mg/dl (7.2+/-2.5 mmol/l) and mean laboratory glucose 123+/-44 mg/dl (6.8+/-2.4 mmol/l). The correlation coefficient between the two values was 0.9110 (Clinical and Laboratory Standards Institute threshold 0.9751). The mean difference (bias) between the two methods was 8.6+/-18.6 mg/dl (0.48+/-1.0 mmol/l) and limits of agreement +45.8 and -28.6 mg/dl (+2.5 and -1.6 mmol/l). Fifty-three (19%) paired measurements in 22 patients were not in accord (CLSI threshold 相似文献   

危重患者血糖管理的实施与安全性评价

目的 评价计算机程序化血糖控制方案的有效性及安全性.方法 回顾性分析2005年6月-2007年12月收入北京同仁医院中心重症监护病房(ICU)的患者,根据目标血糖控制水平分为A组(血糖控制目标4.4～6.1 mmol/L,857例)和B组(血糖控制目标7.3～8.3 mmol/L,894例),用自行制定的计算机程序化血糖管理方案进行血糖管理,记录并追踪两组患者血糖控制情况.结果 共对1 751例患者的26 222次血糖值进行分析.结果 显示:A、B两组患者平均血糖分别为(5.99±0.54)mmol/L和(7.43±0.84)mmol/L,均控制在目标血糖范围内.A、B两组低血糖(<3.3 mmol/L)发生率分别为1.65%(197/11 933)和1.04%(149/14 289);而严重低血糖(<2.2 mmol/L)发生率仅为0.07%(8/11 933)和0.12%(17/14 289),无低血糖相关不良影响发生.在亚组分析中.两组内接受肠内营养(EN)患者的血糖达标率(A组38.77%,B组19.15%)显著低于接受全胃肠外营养(TPN)的患者(A组50.81%,B组23.40%,P均<0.01);且两组接受EN患者高血糖(>8.3 mmol/L)发生率(A组13.68%,B组38.61%)均显著高于TPN患者(A组8.77%,B组29.05%,P均<0.01).低血糖发生率与患者接受营养支持的方式(EN或TPN)无明显相关.结论 在本程序化血糖控制方案指导下实现了ICU患者目标指导下的血糖控制,安全、有效,减少了低血糖的发生和血糖检测次数.但本方案对于控制EN期间血糖方面尚存在欠缺,需进一步完善.     

Insulin therapy improves protein metabolism in the critically ill

ABSTRACT: Critical illness, trauma and burns are associated with profound metabolic abnormalities, of which protein catabolism, hyperglycemia and insulin resistance are hallmarks of these conditions. Increased protein breakdown and loss results in muscle wasting, weakness and diminished functioning. Interestingly, hyperglycemia and insulin resistance augment catabolic responses. Insulin, which is routinely administered to critically ill patients to prevent excessive hyperglycemia, also stimulates protein synthesis and prevents whole-body protein loss. The present commentary highlights the results of a recent study published in Critical Care and discusses whether moderate insulin therapy is equally as beneficial as conventional insulin therapy in preventing protein catabolism and loss.     

International recommendations for glucose control in adult non diabetic critically ill patients

Introduction  

The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients.     

实时动态血糖监测系统在危重症胰岛素强化治疗中作用的荟萃分析

目的 评价实时动态血糖监测系统(RT-CGMS)与传统间断血糖监测方法(IGM)在危重症胰岛素强化治疗(ⅡT)中的作用是否存在差异,以探讨RT-CGMS在危重症强化降低血糖治疗中的意义.方法 系统性检索中文、西文文献数据库中的相关临床随机对照试验(RCT),应用Review Manager 5.2软件进行荟萃分析.评价指标包括:低血糖事件发生率、平均血糖水平、血糖达标时间比例、短期病死率等.结果 共有6篇文献,总计531例患者纳入本次研究.平均血糖水平合并SMD=-0.21(95％ SMD:-0.43 ～0.01,P=0.07);血糖达标比例时间合并SMD=0.20(95％ SMD:-0.09～0.49,P=0.18);低血糖事件发生率合并OR=0.20 (95％ CI:0.09～0.43,P＜0.01);短期病死率合并OR=0.35 (95％ CI:0.14～0.89,P=0.03).结论 危重症强化胰岛素治疗(ⅡT)过程中应用RT-CGMS可明显减少低血糖事件的发生率,但RT-CGMS在保持血糖于理想水平方面比较传统间断血糖监测(IGM)未见明显优势.     

Metoclopramide improves gastric motility in critically ill patients

Objective: To assess the effect of metoclopramide on gastric motility in critically ill patients. Design: Prospective, controlled, single-blind cross-over trial. Setting: A 10-bed general intensive care unit. Patients: Ten critically ill, enterally fed adult patients without renal failure. Interventions: Each patient received enteral feeding with Enrich via a nasogastric tube at 50 ml/h throughout the 5-h study period on two consecutive days. Either normal saline (control) or 10 mg of metoclopramide (treatment) was administered intravenously at the start of the study period in random order with cross-over design. Measurements and results: Gastric motility was measured indirectly by analysis of the absorption over time of 1.5 g of paracetamol administered into the stomach at the start of the study period together with a 100 ml bolus of Enrich feed. The rate of gastric emptying is proportional to the area under the line plot of serum paracetamol concentration against time over 120 min (AUC120). Eight of the ten patients studied showed an increased AUC120 with metoclopramide compared to that with saline. Statistical analysis with the Wilcoxon signed rank test gave a p value of 0.04, indicating a significant increase in gastric emptying following administration of metoclopramide. Conclusions: The administration of intravenous metoclopramide improved gastric emptying in a heterogeneous group of critically ill patients. Metoclopramide is a useful prokinetic drug in this patient population. Final revision received: 18 January 1999 Accepted: 2 March 1999     

危重病患者抢救中胰岛素强化治疗的探讨

目的观察胰岛素强化治疗能否改善重症监护室（ICU）危重患者的预后。方法将116例危重患者随机分为传统治疗组（CT组）和胰岛素强化治疗组（IT组），每4h监测1次床旁血糖。当CT组血糖＞11．9mmol／L时，皮下注射中性可溶性胰岛素控制血糖在10．0～11．1mmol／L；当IT组血糖＞6．1mmol／L时，皮下注射胰岛素控制血糖在4．4～6．1mmol／L。记录患者ICU住院时间、使用呼吸机时间、气管插管或气管套管留置时间、每日早6时平均血糖、每日提供的平均热量、每日胰岛素用量、每日简化治疗干预评分系统-28（TISS-28）评分、人白细胞DR抗原（HLA—DR）、CD4^＋／CD8^＋，死亡、低血糖、肾功能损害（血肌酐＞221／μmol／L）和高胆红素血症（总胆红素＞34．2μmol／L）、输红细胞及发热（口温＞38．5℃）例数。结果CT组病死率（44．83％）远远高于IT组（12．07％），差异有显著性（P＜O．01）；患者ICU住院时间、使用呼吸机时间、气管插管留置时间、每日早6时平均血糖、每日TISS-28评分均明显高于IT组（P＜0．05或P＜0．01）；每日胰岛素用量、HLADR、CD4^＋／CD8^＋均明显低于IT组（P＜0．05或P＜0．01）。两组并发症比较，CT组患者发生肾功能损害、输注红细胞及发热例数均明显高于IT组（P均＜0．01）。结论胰岛素强化治疗控制危重患者血糖在4．4～6．1mmol／L水平确能降低患者的病死率。     

Blood glucose measurements in the critically ill: more than just a blood draw

A crucial determinant for the success of intensive insulin therapy in critically ill patients is the frequent and accurate measurement of blood glucose values with immediate feedback of results. In general, therefore, this is achieved by point-of-care testing, raising the question of the best way of monitoring blood glucose. Corstjens and coworkers, in the previous issue of Critical Care, demonstrate that, in spite of good correlation to "conventional" laboratory glucose assessment, absolute glucose levels may differ systematically. This commentary reviews the problems of glucose measurements arising from matrix effects, interferences and the use of different assays.     

Clinical review: Consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults

The management reporting and assessment of glycemic control lacks standardization. The use of different methods to measure the blood glucose concentration and to report the performance of insulin treatment yields major disparities and complicates the interpretation and comparison of clinical trials. We convened a meeting of 16 experts plus invited observers from industry to discuss and where possible reach consensus on the most appropriate methods to measure and monitor blood glucose in critically ill patients and on how glycemic control should be assessed and reported. Where consensus could not be reached, recommendations on further research and data needed to reach consensus in the future were suggested. Recognizing their clear conflict of interest, industry observers played no role in developing the consensus or recommendations from the meeting. Consensus recommendations were agreed for the measurement and reporting of glycemic control in clinical trials and for the measurement of blood glucose in clinical practice. Recommendations covered the following areas: How should we measure and report glucose control when intermittent blood glucose measurements are used? What are the appropriate performance standards for intermittent blood glucose monitors in the ICU? Continuous or automated intermittent glucose monitoring - methods and technology: can we use the same measures for assessment of glucose control with continuous and intermittent monitoring? What is acceptable performance for continuous glucose monitoring systems? If implemented, these recommendations have the potential to minimize the discrepancies in the conduct and reporting of clinical trials and to improve glucose control in clinical practice. Furthermore, to be fit for use, glucose meters and continuous monitoring systems must match their performance to fit the needs of patients and clinicians in the intensive care setting.See related commentary by Soto-Rivera and Agus, http://ccforum.com/content/17/3/155     

193例危重病患儿血糖变化分析

目的：通过分析193例危重患儿的血糖变化,探讨应激性高血糖对病情进展和预后的影响。方法：对2002年1月-2007年12月在我院PICU住院的193例危重患儿的资料进行回顾性分析,运用t检验、x^2检验、方差分析和相关分析的统计学方法进行比较。结果：①193例危重病患儿中高血糖组有123例,高血糖的发生率为63．7％;血糖最小值为0．9mmol／L,最大值为30．5mmol／L,均值为8．2mmol／L;②123例高血糖患儿中,G3岁组87例（63．0％）,3～7岁组17例（60．7％）,7～10岁组9例（64．3％）,〉10岁组10例（76．9％）,各年龄组高血糖发生率接近（P〉0．05）,均高于正常血糖发生率。③肺炎组发生高血糖有46例,颅内感染组24例,腹泻组11例,心肌炎组2例,感染性休克组11例,非感染性疾病组11例,其他组5例,意外组13例,不同原发病的血糖均数：肺炎为（7．075±2．900）mmol／L,颅内感染（8．259±3．840）mmol／L,腹泻（8．545±5．600）mmol／L,心肌炎（9．052±9．100）mmol／L,感染性休克（11．154±8．000）mmol／L,非感染性疾病（7．358±3．930）mmol／L,其他为（7．246±2．940）mmol／L,意外（12．329±7．890）mmol／L,经方差分析,不同的原发病其血糖升高的水平存在差异（PG0．05）;④正常血糖患儿平均住院时问14．94d,平均住PICU时间9．5d,平均机械通气时间6．472d,而高血糖患儿的平均住院时间18．32d,平均住PICU时间12d,平均机械通气时间10．1901d,经t检验,高血糖组机械通气时间和住PICU时间长于正常血糖组（均P〈0．05）;⑤正常血糖组发生单个脏器损害的有31例,2个脏器损害的14例,3个以上脏器损害的18例,而高血糖组分别为27、41、55例（P〈0．05）,提示高血糖组脏器损害更严重;⑥高血糖组患儿住院7d内死亡人数31例,高于血糖正常组的8例（P〈0．05）,说明高血糖组患儿住院7d内的死亡率高于正常血糖组。结论：危重病患儿常出现高血糖,血糖升高与疾病严重程度有密切联系,血糖水平升高会导致预后不良,是导致死亡率增加和住院时间延长的重要因素,在治疗过程中应严格检测血糖的变化,尽可能将其控制在正常范围内。     

危重患者早期血糖波动与预后的相关性研究

目的 探讨危重患者早期血糖波动与预后的相关性.方法 回顾性分析95例危重患者的临床资料,根据入重症监护病房( ICU )28 d预后分为死亡组(43例)和存活组(52例),监测住ICU 72 h内的血糖,比较两组入ICU时血糖(BGadm)、平均血糖(MBG)、高血糖指数(HGI)、血糖不稳定指数(GLI)、低血糖发生率、胰岛素总用量;通过多因素logistic回归分析确定独立危险因素,并应用受试者工作特征曲线(ROC曲线)下面积(AUC)比较预测价值.结果 死亡组BGadm(mmol/L)、MBG(mmol/L)、HGI、低血糖发生率与存活组比较差异均无统计学意义(BGadm:9.87±4.48比9.26±3.07,MBG:8.59±1.23比847±1.01,HGI6.0:2.45±0.94比1.68±1.05,HGI83:0.84±0.70比0.68±0.51,低血糖发生率:9.30％比5.77％,均P＞0.05);急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(分)、GLI、胰岛素72 h总用量(U)均显著高于存活组[APACHEⅡ评分:23 +6比19±6,GLI:56.96(65.43)比23.87(41.62),胰岛素72 h总用量:65.5( 130.5)比12.5(90.0),均P＜0.05].多因素logistic回归分析显示,APACHEⅡ评分与GLI为死亡独立危险因素[APACHEⅡ评分:优势比(OR)=1.09,95％可信区间(95％CI) 1.01～ 1.17; GLI:OR=1.03,95％口1.01～1.06,均P＜0.05];APACHEⅡ评分与GLI的AUC分别为0.69、0.71,二者无显著差异(P＞0.05).结论 危重患者早期血糖波动是患者入ICU 28 d死亡的独立危险因素,控制早期血糖波动可能有利于改善预后.