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首页> 外文期刊>Therapeutic advances in endocrinology and metabolism. >The clinical significance of hyperglycemia in nondiabetic critically ill multiple trauma patients
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The clinical significance of hyperglycemia in nondiabetic critically ill multiple trauma patients

机译：非糖尿病重症多发性创伤患者高血糖的临床意义

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Information is inconsistent regarding the clinical role of acute elevations of blood glucose level secondary to hospital-acquired infections in nondiabetic critically ill patients during an intensive care unit stay. In this study we investigated the clinical significance of hyperglycemia related to new episodes of ventilator-associated pneumonia in nondiabetic critically ill multiple trauma intensive care unit patients. We analyzed the clinical data of 202 critically ill multiple trauma patients with no history of previous diabetes who developed a new ventilator-associated pneumonia episode during their intensive care unit stay. We used a time-from-event analysis method to assess whether acute changes in blood glucose levels that occurred prior to the onset of ventilator-associated pneumonia episodes had a different prognostic significance from those that occurred during such episodes. Glucose levels and other laboratory data were recorded for up to 5 days before ventilator-associated pneumonia events and for 5 days following these events. Patients who required insulin therapy for persistent hyperglycemia related to a new ventilator-associated pneumonia event had a longer period of intensive care unit stay and a higher intensive care unit mortality rate than patients who did not require insulin for blood glucose control (p 0.008 and 0.001 respectively). In addition, older age, administration of parenteral nutrition, and elevated mean blood glucose level parameters on the day following the day of diagnosis of a new ventilator-associated pneumonia episode were found to be independent risk factors for intensive care unit mortality. Our study suggests that persistent hyperglycemia in nondiabetic critically ill patients, even treated by early insulin therapy, is an adverse prognostic factor of considerable clinical significance.
机译：在重症监护病房住院期间，非糖尿病重症患者因医院获得性感染继发的急性血糖水平升高的临床作用的信息不一致。在这项研究中，我们调查了非糖尿病重症多病重症监护病房患者与新出现的呼吸机相关性肺炎相关的高血糖的临床意义。我们分析了202例无先前糖尿病史的重症多发性创伤患者的临床数据，这些患者在重症监护病房住院期间出现了新的呼吸机相关性肺炎发作。我们使用事件发生时间分析方法来评估在呼吸机相关性肺炎发作之前发生的血糖水平急性变化是否具有与此类发作期间发生的预后不同的预后意义。在呼吸机相关性肺炎事件发生之前的5天内以及这些事件发生之后的5天内记录了葡萄糖水平和其他实验室数据。与新的呼吸机相关性肺炎事件相关的，需要持续持续高血糖的胰岛素治疗的患者，与不需要胰岛素控制血糖的患者相比，重症监护病房住院时间更长，重症监护病房死亡率更高（p <0.008和分别<0.001）。此外，发现新的呼吸机相关性肺炎发作后第二天，老年人的年龄，肠胃外营养的给予以及平均血糖水平参数升高是重症监护病房死亡率的独立危险因素。我们的研究表明，即使通过早期胰岛素治疗，在非糖尿病危重患者中持续存在的高血糖也是具有重大临床意义的不良预后因素。

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