Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission 糖尿病合并肺炎住院患者的应激性高血糖率与全身性炎症和临床结局相关

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Pub Date : 2023-05-05 DOI:10.1111/1753-0407.13398

Bing Liu, Yu Chen, Liping Yu, Min Zhou

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Abstract

Backgrounds

Stress hyperglycemia ratio (SHR) reflects the acute blood glucose change in response to acute illnesses or injuries, including pneumonia. We aimed to investigate the associations of SHR with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission.

Methods

A multicenter and retrospective study was conducted among diabetic inpatients with pneumonia on admission via electronic medical records from 2013 to 2019 in Ruijin Hospital, Shengjing Hospital, and China-Japan Friendship Hospital.

Results

The study included 1631 diabetic inpatients with pneumonia on admission. Patients of the fourth quartile (Q4) of SHR on admission showed significantly elevated systemic inflammation compared with those of the first quartile (Q1), second quartile (Q2), or third quartile (Q3) of SHR, including more white blood cells (9.1 × 10⁹/L in Q4 vs 7.6 × 10⁹/L in Q1, 7.9 × 10⁹/L in Q2, and 8.0 × 10⁹/L in Q3, p < .001), higher neutrophil-to-lymphocyte ratio (7.0 in Q4 vs 3.6 in Q1, 3.8 in Q2, and 4.0 in Q3, p < .001), higher C-reactive protein (52.8 mg/L in Q4 vs 18.9 mg/L in Q1, p < .001; 52.8 mg/L in Q4 vs 28.6 mg/L in Q2, p = .002), higher procalcitonin (0.22 ng/mL in Q4 vs 0.10 ng/mL in Q1, 0.09 ng/mL in Q2, and 0.11 ng/mL in Q3, p < .001), and higher D-dimer (0.67 mg/L in Q4 vs 0.47 mg/L in Q1, 0.50 mg/L in Q2, and 0.47 mg/L in Q3, p < .001). Excluding patients with hypoglycemia on admission in the analyses, there were still distinct J-shaped associations between SHR and adverse clinical outcomes in patients with different severity of pneumonia, especially in those with CURB-65 score for pneumonia severity (Confusion, blood Urea nitrogen, Respiratory rate, Blood pressure) ≥ 2. In the multivariable regression model, predictive value for adverse clinical outcomes was higher when SHR was taken as a spline term than as quartiles in all patients (area under curve 0.831 vs 0.822, p = .040), and when SHR as a spline term instead of fasting blood glucose was included in patients with CURB-65 ≥ 2 (area under curve 0.755 vs 0.722, p = .027).

Conclusions

SHR was correlated with systematic inflammation and of J-shaped associations with adverse clinical outcomes in diabetic inpatients with pneumonia of different severity. The inclusion of SHR in the blood glucose management of diabetic inpatients may be beneficial, especially for the prevention of potential hypoglycemia or the recognition of relative glucose insufficiency in those with severe pneumonia or high hemoglobin A_1C.

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Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission 糖尿病合并肺炎住院患者的应激性高血糖率与全身性炎症和临床结局相关

应激性高血糖比(SHR)反映了急性疾病或损伤(包括肺炎)后的急性血糖变化。我们的目的是研究SHR与糖尿病合并肺炎住院患者全身性炎症和临床结局的关系。方法对瑞金医院、盛京医院和中日友好医院2013 - 2019年通过电子病历入院的糖尿病合并肺炎患者进行多中心回顾性研究。结果纳入1631例入院时合并肺炎的糖尿病住院患者。第四个四分位数的患者(Q4)月入院时显示显著升高系统性炎症相比第一四分位数(Q1),第二个四分位数(Q2),或第三四分位数(Q3)萎缩,包括白细胞(9.1×109年第四季度/ L和7.6×109第一季度/ L, 7.9×109 / L在Q2,和8.0×109年第三季度/ L p & lt;措施),高neutrophil-to-lymphocyte比率(第四季度的7.0 vs 3.6第一季度,第二季度的3.8,和4.0在第三季度,p & lt;措施),更高的c反应蛋白(Q4为52.8 mg/L, Q1为18.9 mg/L, p < 001;Q4为52.8 mg/L, Q2为28.6 mg/L, p = .002)，降钙素原较高(Q4为0.22 ng/mL, Q1为0.10 ng/mL, Q2为0.09 ng/mL, Q3为0.11 ng/mL, p < 001)， d -二聚体较高(Q4为0.67 mg/L, Q1为0.47 mg/L, Q2为0.50 mg/L, Q3为0.47 mg/L, p < 001)。在分析中排除入院时出现低血糖的患者，不同严重程度肺炎患者的SHR与不良临床结局之间仍存在明显的j型相关性，特别是在肺炎严重程度(意识混乱、血尿素氮、呼吸频率、血压)的CURB-65评分≥2的患者中。在多变量回归模型中，所有患者以SHR作为样条项时(曲线下面积0.831 vs 0.822, p = 0.040)，以及在CURB-65≥2的患者中以SHR作为样条项而不是空腹血糖时(曲线下面积0.755 vs 0.722, p = 0.027)，不良临床结局的预测值更高。结论糖尿病住院合并不同严重程度肺炎患者SHR与全身炎症相关，与不良临床结局呈j型相关。将SHR纳入糖尿病住院患者的血糖管理可能是有益的，特别是对于预防潜在的低血糖或识别严重肺炎或高糖化血红蛋白患者的相对葡萄糖不足。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.