[Association between blood glucose trajectory and prognosis in septic patients in intensive care unit].
摘要
OBJECTIVE: To investigate the relationship between dynamic blood glucose trajectories within 7 days of intensive care unit (ICU) admission and the risks of death and hypoglycemia in patients with sepsis. METHODS: Based on data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV), adult patients with sepsis who had at least one blood glucose measurement per day within 7 days of ICU admission were selected as study subjects. Group-based trajectory modeling (GBTM) was used to analyze blood glucose trajectories within 7 days of ICU admission and determine the optimal number of subgroups. General patient information (gender, age, race, ICU type), disease status (disease severity scores, comorbidities), and monitoring, laboratory parameters, and treatments during the first 24 hours of ICU admission were collected. The primary outcome was the 28-day cumulative survival rate. Secondary outcomes included the 1-year cumulative survival rate, in-hospital mortality, ICU mortality, and the incidence of hypoglycemia. The clinical characteristics of patients with different glucose trajectories were analyzed. Kaplan-Meier survival curve was used to analyze the relationship between glucose trajectories and 28-day and 1-year cumulative survival. Multivariate Logistic regression analysis or Firth regression analysis was employed to explore the relationship between glucose trajectories and in-hospital death, ICU death, and the occurrence of hypoglycemia within 7 days of ICU admission. RESULTS: =62.186, P<0.001). Multivariate Logistic regression analysis, after adjusting for relevant variables, revealed that as blood glucose levels increased, in-hospital mortality and ICU mortality gradually rised [in-hospital mortality rates for the normal low-limit, moderate-level, and sustained high-level groups were 10.66% (350/3 283), 14.51% (527/3 631), and 20.01% (402/2 009), respectively; ICU mortality rates were 7.46% (245/3 283), 10.80% (392/3 631), and 16.38% (329/2 009), respec