摘要
目的 探讨时间加权平均静脉血糖(time-weighted average glucose, TWAG)对重症急性肾损伤(acute renal injury, AKI)患者短期预后的影响。 方法 本研究资料来源于medical information mart for intensive care(MIMIC)-Ⅲ数据库,首次入重症监护室(intensive care unit, ICU)并诊断为重症AKI的患者为研究对象。采用PostgreSQL11提取感兴趣数据。入ICU期间 TWAG值用于评估患者血糖水平,以7.8 mmol/L为分界线分为TWAG≥7.8 mmol/L组和TWAG< 7.8 mmol/L组,以院内死亡、30 d死亡为本研究的主要研究终点。并予以倾向性评分匹配、逆概率加权和Logistic回归模型分析TWAG与重症AKI短期预后的关系。 结果 本研究共纳入5848例重症AKI患者,院内病死率为24.0%,30 d病死率为25.6%。经单因素、多因素回归分析, 发现在倾向性评分匹配调整前、倾向性评分匹配后以及协变量调整倾向性评分后,TWAG≥ 7.8 mmol/L 组短期死亡风险均较TWAG<7.8 mmol/L组高( P<0.001 );进一步进行逆概率加权分析的结果类似,当TWAG≥7.8 mmol/L时院内死亡风险增加52%( OR 1.52,95% CI 1.35~ 1.71 , P<0.001 ),30 d死亡风险增加53%( OR 1.53,95% CI 1.36~1.72, P<0.001 )。 结论 TWAG≥7.8 mmol/L是重症AKI患者短期预后的危险因素,故对重症AKI患者进行医治时应对其血糖水平予以严格检测和控制。
Objective To study the effect of time-weighted average glucose(TWAG)level on the short-term prognosis of patients with severe acute renal injury(AKI).Methods The data of this study were from the medical information mart for intensive care(MIMIC)-Ⅲdatabase.The patients with AKI admitted to ICU for the first time were included in this study.PostgreSQL 11 was used to extract the interesting data.The TWAG value during ICU was calculated to evaluate the blood glucose level of patients.The patients were divided into two groups by the TWAG value of 7.8 mmol/L(TWAG≥7.8 mmol/L group and TWAG<7.8 mmol/L group).In-hospital and 30-day mortality were the major end points of this study.The relationship between TWAG and short-term prognosis of patients with AKI was analyzed by propensity score matching(PSM),inverse probability of treatment weighting(IPTW)method and Logistic regression model.Results A total of 5848 patients with AKI were included in this study.In-hospital and 30-day mortality was 24.0%and 25.6%,respectively.Univariate and multivariate regression analysis showed that the risk of short-term mortality in the group of TWAG≥7.8 mmol/L was higher than that in the group of TWAG<7.8 mmol/L before the adjustment of PSM,after the PSM,after covariate adjusted propensity score(P<0.001);Further IPTW analysis showed similar results,the risk of in-hospital mortality increased by 52%(OR 1.52,95%CI 1.35-1.71,P<0.001),the risk of 30-day mortality increased by 53%(OR 1.53,95%CI 1.36-1.72,P<0.001)when TWAG≥7.8 mmol/L.Conclusions TWAG≥7.8 mmol/L is a risk factor for short-term prognosis of critically ill patients with AKI.Therefore,the blood glucose level of patients with severe AKI should be strictly detected and controlled during clinical treatment.
作者
李涛
郭永力
何阳
田伊茗
Li Tao;Guo Yong-li;He Yang;Tian Yi-ming(Department of Nephrology,Qinhuangdao First Hospital,Qinhuangdao 066000,China)
出处
《中国急救医学》
CAS
CSCD
2022年第11期952-956,共5页
Chinese Journal of Critical Care Medicine
