糖尿病和入院高血糖对严重脓毒症患者预后的影响

目的:探讨糖尿病、入院高血糖对严重脓毒症患者预后的影响。方法:回顾分析我院2015-03-2019-12期间ICU收治的275例严重脓毒症患者的临床资料,根据病史分为糖尿病(DM)组、非糖尿病(Non-DM)组。比较2组患者的基线特征、慢性病并发症、实验参数、24 h内急性生理与慢性健康评分(APACHCEⅡ)、入院血糖值。分析糖尿病、入院高血糖对严重脓毒症患者预后的影响。通过校正混杂因素,我们对脓毒症患者死亡风险因素进行Logistics回归分析。结果:DM患者所占的比例为27.27%(75/275)。DM组与Non-DM组相比,患者年龄偏大,慢性肾病患者比例偏高,APACHCEⅡ评分差异无统计学意义,病死率略偏低(OR=0.79,95%CI:0.41~1.52,P=0.48)。在Non-DM组,入院高血糖组(血糖>11.1 mmol/L)较血糖正常组(血糖4.0~11.1 mmol/L)患者病死率明显增高(OR=2.22,95%CI:1.12~4.40,P=0.02),在DM组则不明显。Logistics回归分析提示DM可降低严重脓毒症患者死亡风险(OR=0.83,95%CI:0.63~0.94,P=0.04)。结论:糖尿病似乎是严重脓毒症患者预后的保护因素。在非糖尿病患者中,入院高血糖与患者预后不良明显相关,在糖尿病患者中则不明显。

Effect of diabetes and admission high glucose on the prognosis of patients with severe sepsis

Objective:To study the effect of diabetes and admission high glucose on the prognosis of patients with severe sepsis. Method:A total of 275 patients with severe sepsis treated in our hospital from March 2015 to December 2019 were retrospectively analyzed, and according to the presence of diabetes, they were divided into diabetes group and non diabetes group. We compared patients’ demographics, clinical and laboratory parameters, admission glucose levels and acute physiology and chronic health evaluation Ⅱ(APACHCE Ⅱ) scores within 24 hoursbetween the two groups. Diabetes and admission high glucose on the prognosis of patients were analyzed. We created Logistics models to analyze odds ratio of mortality after adjusting for possible confounders. Result:Diabetes was presented in 27.27%(75/275) of all patients. Diabetic patients were older, more likely to have chronic renal disease, but similar severity and lower mortality rate(OR=0.79, 95%CI:0.41-1.52, P=0.48). Hyperglycemia at admission(glucose>11.1 mmol/L) was associated with high risk of mortality among non-diabetes(OR=2.22, 95%CI:1.12-4.40, P=0.02), but not in diabetic patients. By using multivariable Logistic regression model, presenting with diabetes was found to be associated with reduced risk of mortality(OR=0.83, 95%CI:0.63-0.94, P=0.04).Conclusion:This study indicated that while diabetes seems to be a protective factor in sepsis patients. High initial glucose levels were associated with adverse outcomes in non-diabetes only.