Background: Association of diabetes and admission glucose on the short-term prognosis in patients with critical illnesses are currently ambiguous. We aimed to determine whether diabetes and admission glucose affects short-term prognosis of critically ill patients.
Methods: We performed a retrospective analysis of data on 46,476 critically ill patients from the critical care database. Association of diabetes with 28-day mortality was assessed by inverse probability weighting based on the propensity score. Smoothing splines and threshold effect analysis were applied to explore the relationship between admission glucose and clinical outcomes.
Results: Of the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetes. In the main analysis, the 28-day mortality was reduced by 29% (hazard ratio (HR)=0.71, 95% confidence interval (CI) 0.67– 0.76) in patients with diabetes compared to those without diabetes. The E-value of 2.17 indicated robustness to unmeasured confounders. Significant interactions were observed for glucose at ICU admission, admission type, and insulin use (Interaction P < 0.05). A V-shaped relationship was observed between admission glucose and 28-day mortality in non-diabetic patients, with the lowest 28-day mortality corresponding to a glucose level of 101.75 mg/dl (95% CI 94.64– 105.80 mg/dl), and admission hypoglycemia or hyperglycemia should be avoided, especially in patients admitted to the surgical intensive care unit (SICU), cardiac surgery recovery unit (CSRU), and coronary care unit (CCU); for diabetic patients, elevated admission glucose does not appear to be associated with a poor prognosis and perhaps may be beneficial except for CCU and CSRU.
Conclusion: The non-detrimental effect of diabetes on the short-term prognosis of critically ill patients was further confirmed, which would reduce 28-day mortality by approximately 29%. For non-diabetic patients, the admission glucose level corresponding to the lowest 28-day mortality was 101.75 mg/dl (95% CI 94.64– 105.80 mg/dl); however, for diabetics, the appropriate admission glucose threshold remains unresolved.



中文翻译：

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糖尿病和入院血糖水平与危重病患者短期预后的关系

背景：糖尿病和入院血糖对危重病患者短期预后的关联目前尚不明确。我们旨在确定糖尿病和入院血糖是否会影响危重患者的短期预后。
方法：我们对来自重症监护数据库的 46,476 名重症患者的数据进行了回顾性分析。通过基于倾向评分的逆概率加权评估糖尿病与 28 天死亡率的关系。应用平滑样条和阈值效应分析来探索入院血糖与临床结果之间的关系。
结果：在参加该研究的 33,680 名患者中，8,701 名（25.83%）患有糖尿病。在主要分析中，与非糖尿病患者相比，糖尿病患者的 28 天死亡率降低了 29%（风险比 (HR)=0.71，95% 置信区间 (CI) 0.67-0.76）。2.17 的 E 值表明对未测量的混杂因素的稳健性。在 ICU 入院、入院类型和胰岛素使用时观察到葡萄糖的显着交互作用（交互作用P< 0.05)。在非糖尿病患者的入院血糖和 28 天死亡率之间观察到 V 型关系，最低的 28 天死亡率对应于 101.75 mg/dl 的血糖水平（95% CI 94.64–105.80 mg/dl），应避免入院时出现低血糖或高血糖，尤其是入住外科重症监护病房（SICU）、心脏手术恢复病房（CSRU）和冠状动脉监护病房（CCU）的患者；对于糖尿病患者，入院时血糖升高似乎与预后不良无关，并且可能对 CCU 和 CSRU 之外的其他患者有益。
结论：糖尿病对危重患者短期预后的非不利影响得到进一步证实，可将28天死亡率降低约29%。对于非糖尿病患者，对应最低 28 天死亡率的入院血糖水平为 101.75 mg/dl（95% CI 94.64–105.80 mg/dl）；然而，对于糖尿病患者，合适的入院血糖阈值仍未解决。