Association of glycemic variability and prognosis in patients with traumatic brain injury: A retrospective study from the MIMIC-IV database

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2024-09-26 DOI:10.1016/j.diabres.2024.111869

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引用次数: 0

Abstract

Background

Elevated glycemic variability (GV) often occurs in intensive care unit (ICU) patients and is associated with patient prognosis. However, the association between GV and prognosis in ICU patients with traumatic brain injury (TBI) remains unclear.

Method

Clinical data of ICU patients with TBI were obtained from the Medical Information Mart for Intensive Care (MIMIC) -IV database. The coefficient of variation (CV) was utilized to quantify GV, while the Glasgow Coma Scale (GCS) was employed to evaluate the consciousness status of TBI patients. Pearson linear correlation analysis, linear regression, COX regression and restricted cubic spline (RCS) were used to investigate the relationship between CV and consciousness impairment, as well as the risk of in-hospital mortality.

Result

A total of 1641 ICU patients with TBI were included in the study from the MIMIC-IV database. Pearson linear correlation and restricted cubic spline (RCS) analysis results showed a negative linear relationship between CV and the last GCS (P = 0.002) with no evidence of nonlinearity (P for nonlinear = 0.733). Multivariable linear regression suggested a higher CV was associated with a lower discharge GCS [β (95 %CI) = −1.86 (−3.08 ∼ −0.65), P = 0.003]. Furthermore, multivariable COX regression indicated that CV ≥ 0.3 was a risk factor for in-hospital death in TBI patients [HR (95 %CI) = 1.74 (1.15–2.62), P = 0.003], and this result was also consistent across sensitivity and subgroup analyses.

Conclusion

Higher GV is related to poorer consciousness outcomes and increased risk of in-hospital death in ICU patients with TBI. Additional research is needed to understand the logical relationship between GV and TBI progression.

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脑外伤患者血糖变化与预后的关系：来自 MIMIC-IV 数据库的回顾性研究。

背景：重症监护病房（ICU）患者的血糖变异性（GV）通常会升高，并且与患者的预后有关。然而，重症监护病房创伤性脑损伤（TBI）患者的血糖变异性与预后之间的关系仍不清楚：方法：重症监护病房创伤性脑损伤患者的临床数据来自重症监护医学信息市场（MIMIC）-IV 数据库。变异系数（CV）用于量化GV，格拉斯哥昏迷量表（GCS）用于评估TBI患者的意识状态。研究采用了皮尔逊线性相关分析、线性回归、COX回归和受限立方样条线（RCS）来研究变异系数与意识障碍之间的关系以及院内死亡风险：研究共纳入了1641名来自MIMIC-IV数据库的ICU创伤性脑损伤患者。皮尔逊线性相关和限制性立方样条曲线（RCS）分析结果显示，CV 与最后一次 GCS 之间存在负线性关系（P = 0.002），且无证据表明存在非线性关系（非线性关系的 P = 0.733）。多变量线性回归表明，较高的 CV 与较低的出院 GCS 相关[β（95 %CI）=-1.86 (-3.08 ∼ -0.65)，P = 0.003]。此外，多变量 COX 回归表明，CV ≥ 0.3 是导致 TBI 患者院内死亡的危险因素 [HR (95 %CI) = 1.74 (1.15-2.62)，P = 0.003]，这一结果在敏感性分析和亚组分析中也是一致的：结论：较高的 GV 与创伤性脑损伤重症监护病房患者较差的意识状况和较高的院内死亡风险有关。要了解 GV 与创伤性脑损伤进展之间的逻辑关系，还需要进行更多的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.