Diabetes Care:COVID-19住院患者入院血糖水平与心血管和肾脏并发症之间的关系

2022-03-14 MedSci原创 MedSci原创

入院血糖水平,高血糖和低血糖与心血管或肾脏并发症的几率增加相关。入院血糖可作为高危患者风险分层的标志物。

近日,糖尿病领域权威杂志Diabetes Care上发表了一篇研究文章,研究人员旨在调查入院血糖水平与院内心血管和肾脏并发症风险之间的关系。

在这项针对2020年2月6日至2021年3月16日期间因COVID-19住院的36269名成人(N=143266)的多中心前瞻性研究中,研究人员使用Logistic回归模型来探索入院血糖水平(mmol/L和mg/dL)与院内并发症,包括心力衰竭、心律失常、心脏缺血、心脏骤停、凝血并发症、卒中和肾损伤,发生几率之间的关联。研究人员使用受限三次样条研究非线性。相互作用模型探讨了葡萄糖水平和并发症之间的关联是否被临床相关因素所改变。

10421(28.7%)名患者发生心血管和肾脏并发症;入院血糖中位水平为6.7mmol/L(四分位距为5.8-8.7)(120.6mg/dL[104.4-156.6])。在考虑混杂因素的同时,对于除心脏缺血和卒中以外的所有并发症,葡萄糖与心血管和肾脏并发症之间存在非线性关联。例如,心力衰竭、心律失常、凝血并发症和肾损伤的几率降至最低点,分别为6.4mmol/L(115mg/dL)、4.9mmol/L(88.2mg/dL)、4.7mmol/L(84.6mg/dL)和5.8mmol/L(104.4mg/dL),之后分别增加至26.0mmol/L(468mg/dL)、50.0mmol/L(900mg/dL)、8.5mmol/L(153mg/dL)和32.4mmol/L(583.2mg/dL)。与5mmol/L(90mg/dL)相比,在这些血糖水平下,心力衰竭的比值比为1.28(95%CI0.96,1.69),心律失常的比值比为2.23(1.03,4.81),凝血的比值比为1.59(1.36,1.86),肾损伤比值比为2.42(2.01,2.92)。

对于大多数并发症,研究人员观察到了年龄的修正效应,对于年龄<69岁的患者,较高的血糖水平发生并发症的几率较高。既往存在的糖尿病状态对并发症的几率有类似的调整效应,但肾损伤、心脏缺血和任何心血管/肾脏并发症的证据最强。

由此可见,入院血糖水平,高血糖和低血糖与心血管或肾脏并发症的几率增加相关。入院血糖可作为高危患者风险分层的标志物。进一步的研究应评估干预措施来优化入院血糖以改善COVID-19患者结局。

原始出处:
 
Tom Norris,et al.Admission Blood Glucose Level and Its Association With Cardiovascular and Renal Complications in Patients Hospitalized With COVID-19.Diabetes care.2022.https://diabetesjournals.org/care/article/doi/10.2337/dc21-1709/144732/Admission-Blood-Glucose-Level-and-Its-Association

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    2022-07-16 丁鹏鹏
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    2022-03-15 13746658d9m

    学习了

    0

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    2022-03-15 ms5000001096872920

    学习

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