Insulin requirement trajectories during COVID-19 versus non-COVID-19 critical illness-A retrospective cohort study.

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Acta Anaesthesiologica Scandinavica Pub Date : 2025-01-01 Epub Date: 2024-10-14 DOI:10.1111/aas.14536

Navid Soltani, Henrike Häbel, Anca Balintescu, Marcus Lind, Jonathan Grip, Ragnar Thobaben, David Nelson, Johan Mårtensson

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引用次数: 0

Abstract

Background: The glycemic response to critical COVID-19 remains uncertain. We aimed to assess the association between COVID-19, insulin requirements, glycemic control, and mortality in intensive care unit (ICU) patients.

Methods: We conducted a retrospective observational study of 350 COVID-19 patients and 1067 non-COVID-19 patients admitted to the ICU. Insulin requirement was defined as the total units of exogenous insulin required to cover one gram of administered carbohydrates (insulin-to-carbohydrate ratio, ICR). We used multivariable generalized linear mixed-model (GLMM) analysis to assess the association of the interaction between COVID-19 and ICU-day with daily ICR, adjusted for fixed and time-dependent covariates. Glycemic control was assessed after stratification on diabetes and COVID-19. We used multivariable logistic regression analysis to assess the association between ICR and 90-day mortality.

Results: The mean (95% CI) of the mean daily ICR among patients without diabetes was 0.09 (0.08-0.11) U/g and 0.15 (0.11-0.18) U/g in the non-COVID-19 group and COVID-19 group (p = .01), respectively. In diabetes patients, the corresponding ICRs were 0.52 (0.43-0.62) U/g and 0.59 (0.50-0.68) U/g (p = .32). In multivariable GLMM analysis, the interaction between COVID-19 and ICU-day was independently associated with ICR (risk estimate 1.22, 95% CI 1.15-1.31, p < .001). COVID-19 was associated with higher hypoglycemia prevalence irrespective of diabetes status, higher average glucose levels, more pronounced glucose variability, and a lower proportion of glucose values within target range among patients without diabetes. On multivariable logistic regression analysis, the adjusted odds ratio for 90-day mortality was 1.77 (95% CI 0.94-3.34, p = .076) per one unit increase in mean ICR.

Conclusion: In our cohort of ICU patients, COVID-19 was associated with higher daily insulin requirements per gram of administered carbohydrates, and worse glycemic control. We found no robust association between ICR and increased odds of death at 90 days.

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COVID-19 与非 COVID-19 危重病期间的胰岛素需求轨迹--一项回顾性队列研究。

背景：临界 COVID-19 的血糖反应仍不确定。我们旨在评估 COVID-19、胰岛素需求、血糖控制和重症监护病房（ICU）患者死亡率之间的关联：我们对重症监护室收治的 350 名 COVID-19 患者和 1067 名非 COVID-19 患者进行了回顾性观察研究。胰岛素需求量的定义是：覆盖一克给药碳水化合物所需的外源性胰岛素总单位（胰岛素-碳水化合物比值，ICR）。我们使用多变量广义线性混合模型（GLMM）分析评估了 COVID-19 和 ICU 日与每日 ICR 之间的交互作用关系，并对固定协变量和时间依赖协变量进行了调整。在对糖尿病和 COVID-19 进行分层后，对血糖控制情况进行了评估。我们使用多变量逻辑回归分析评估了 ICR 与 90 天死亡率之间的关系：非 COVID-19 组和 COVID-19 组非糖尿病患者的平均每日 ICR 分别为 0.09 (0.08-0.11) U/g 和 0.15 (0.11-0.18) U/g (p = .01)（95% CI）。在糖尿病患者中，相应的 ICR 分别为 0.52 (0.43-0.62) U/g 和 0.59 (0.50-0.68) U/g (p = .32)。在多变量 GLMM 分析中，COVID-19 与 ICU 日之间的交互作用与 ICR 独立相关（风险估计值 1.22，95% CI 1.15-1.31，p 结论：COVID-19 与 ICU 日之间的交互作用与 ICR 独立相关：在我们的 ICU 患者队列中，COVID-19 与每克碳水化合物的每日胰岛素需求量较高和血糖控制较差有关。我们发现，ICR 与 90 天后死亡几率增加之间没有明显的关联。

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

Acta Anaesthesiologica Scandinavica 医学-麻醉学

CiteScore

4.30

自引率

9.50%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Acta Anaesthesiologica Scandinavica publishes papers on original work in the fields of anaesthesiology, intensive care, pain, emergency medicine, and subjects related to their basic sciences, on condition that they are contributed exclusively to this Journal. Case reports and short communications may be considered for publication if of particular interest; also letters to the Editor, especially if related to already published material. The editorial board is free to discuss the publication of reviews on current topics, the choice of which, however, is the prerogative of the board. Every effort will be made by the Editors and selected experts to expedite a critical review of manuscripts in order to ensure rapid publication of papers of a high scientific standard.