危重COPD患者应激性高血糖率升高预示不良临床结局:一项回顾性研究

IF 2.7 3区 医学 Q2 RESPIRATORY SYSTEM
Mengyuan Qiao, Hui Yang, Mengzhen Qin, Yingyang Li, Haiyan Wang
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引用次数: 0

摘要

目的:应激性高血糖率(Stress high glycemia ratio, SHR)作为相对高血糖的一项指标,被广泛应用于危重症患者的预后预测。本研究旨在探讨慢性阻塞性肺病危重患者SHR与不良临床结局的关系。方法:本回顾性队列研究共纳入1580例诊断为COPD的患者。SHR = ABG (mmol/L) / [1.59 × HbA1c(%) - 2.59]。主要终点包括ICU死亡率和住院死亡率。次要终点是慢性阻塞性肺疾病(AECOPD)急性加重和急性呼吸衰竭(ARF)。采用Logistic回归、限制性立方样本(RCS)和受试者工作特征(ROC)探讨SHR与COPD患者预后的关系。此外,还进行了亚组分析和相互作用试验,以调查潜在的异质性。结果:多因素logistic回归分析显示SHR升高与ICU死亡率和住院死亡率无关。相反,SHR四分位数与ICU死亡率和住院死亡率相关。限制性三次样条回归模型显示SHR与ICU死亡率和住院死亡率之间存在非线性相关性(所有PROC分析均显示SHR比入院血糖(ABG)和血红蛋白A1c (HbA1c)更有效地预测COPD患者的死亡率和预后,前者更能预测死亡率和预后。在亚组分析中,在调整本研究中考虑的所有协变量后,SHR与COPD患者预后风险之间的关系在性别、年龄、BMI、吸烟、饮酒、高血压史、冠心病、糖尿病和脑血管疾病中保持稳定。结论:SHR与危重COPD患者不良临床结局风险增加独立相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Increased Stress Hyperglycemia Ratio Predicts Poor Clinical Outcome in Critically Ill COPD Patients: A Retrospective Study.

Objective: Stress hyperglycemia ratio (SHR) was introduced as an indicator of relative hyperglycaemia and is widely used for prognostic prediction in critically ill patients. The present study aimed to investigate the relationship between SHR and adverse clinical outcomes in critically ill COPD patients.

Methods: A total of 1,580 patients diagnosed with COPD were included in this retrospective cohort study. SHR = ABG (mmol/L) / [1.59 × HbA1c (%) - 2.59]. Primary endpoints included ICU mortality and in-hospital mortality. Secondary endpoints were acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute respiratory failure (ARF). Logistic regression, Restricted Cubic Sample (RCS) and Receiver Operating Characteristic (ROC) were used to explore the relationship between SHR and prognosis of COPD patients. In addition, subgroup analyses and interaction tests were performed to investigate potential heterogeneity.

Results: Multivariate logistic regression analysis showed that elevated SHR was not associated with ICU mortality and in-hospital mortality. In contrast, SHR quartiles were correlated with ICU mortality and in-hospital mortality. Restricted cubic spline regression models showed a nonlinear correlation between SHR and both ICU mortality and in-hospital mortality (all P<0.001). In addition, a linear correlation was found between SHR and AECOPD and ARF, with elevated SHR associated with increased risk of AECOPD and ARF. ROC analyses showed that SHR was a more effective predictor of mortality and prognosis than admission blood glucose (ABG) and hemoglobin A1c (HbA1c) in patients with COPD, with the former being a better predictor of mortality and prognosis. In subgroup analyses, after adjusting for all covariates considered in the present study, the relationship between SHR and prognostic risk in patients with COPD remained stable across gender, age, BMI, smoking, drinking, history of hypertension, coronary heart disease, diabetes, and cerebrovascular disease.

Conclusion: SHR is independently associated with an increased risk of adverse clinical outcomes in critically ill COPD patients.

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来源期刊
CiteScore
4.80
自引率
10.70%
发文量
372
审稿时长
16 weeks
期刊介绍: An international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus will be given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self management protocols. This journal is directed at specialists and healthcare professionals
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