■心脏手术患者血糖和谵妄风险的研究结果不一致,在如何管理冠状动脉旁路移植术(CABG)后的血糖方面也存在差距。本研究以糖尿病(DM)行CABG患者为研究对象,探讨不同血糖相关指标及血糖变化轨迹与术后谵妄(POD)的关系。目的是为该人群的血糖管理提供一些信息。
■在这项回顾性队列研究中,从重症监护医学信息集市(MIMIC)-IV数据库中提取了接受CABG的DM患者的数据。血糖相关指标包括基线血糖,平均血糖(MBG),平均绝对葡萄糖(MAG),平均血糖波动幅度(MAGE),血糖不稳定指数(GLI),和最大幅度的血糖偏移(LAGE)。使用潜在生长混合物建模(LGMM)方法对MBG轨迹进行分类。采用单因素和多因素logistic回归分析筛选协变量,探讨血糖相关指标和MBG轨迹与POD的关系。这些关系也在年龄亚组中进行了评估,性别,种族,估计肾小球滤过率(eGFR),国际标准化比率(INR),脓毒症,机械通风使用,和血管加压药的使用。此外,研究了血糖和肝肾功能对POD的潜在交互作用。评价指标为优势比(OR),相互作用导致的相对超额风险(RERI),可归因互动比例(AP),和95%置信区间(CI)。
■在符合条件的1,951名患者中,180有POD。在调整协变量后,MBG水平较高(OR=3.703,95%CI:1.743-7.870),MAG>0.77mmol/L/h(OR=1.754,95%CI:1.235-2.490),GLI>2.6(mmol/L)2/h/h(OR=1.458,95%CI:1.033-2.058)与更高的POD几率相关。MBG的正相关,MAG,在年龄<65岁的患者中观察到有POD的GLI,男性患者,白人患者,那些eGFR<60和INR<1.5,脓毒症患者,以及接受机械通气和血管加压药的患者(均p<0.05)。3级(OR=3.465,95%CI:1.122-10.696)和4级(OR=3.864,95%CI:2.083-7.170)的患者MBG轨迹似乎具有更高的POD几率,与具有1级MBG轨迹的人相比。此外,MAG(RERI=0.71,95%CI:0.14-1.27,AP=0.71,95%CI:0.12-1.19)和GLI(RERI=0.78,95%CI:0.19-1.39,AP=0.69,95%CI:0.16-1.12)均与INR对POD具有潜在的协同作用。
■关注MBG的水平,MAG,GLI,对于接受CABG的DM患者,MBG轨迹可能比ICU入院时的血糖水平更有利于评估POD的潜在风险.
UNASSIGNED: Study results on blood glucose and the risk of delirium in patients receiving cardiac surgery are inconsistent, and there is also a gap in how to manage blood glucose after coronary artery bypass grafting (CABG). This study focused on patients with diabetes mellitus (DM) undergoing CABG and explored the associations of different blood glucose-related indexes and blood glucose change trajectory with postoperative delirium (
POD), with the aim of providing some information for the management of blood glucose in this population.
UNASSIGNED: Data of patients with DM undergoing CABG were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database in this retrospective cohort study. The blood glucose-related indexes included baseline blood glucose, mean blood glucose (MBG), mean absolute glucose (MAG), mean amplitude of glycemic excursions (MAGE), glycemic lability index (GLI), and largest amplitude of glycemic excursions (LAGE). The MBG trajectory was classified using the latent growth mixture modeling (LGMM) method. Univariate and multivariate logistic regression analyses were utilized to screen covariates and explore the associations of blood glucose-related indexes and MBG trajectory with POD. These relationships were also assessed in subgroups of age, gender, race, estimated glomerular filtration rate (eGFR), international normalized ratio (INR), sepsis, mechanical ventilation use, and vasopressor use. In addition, the potential interaction effect between blood glucose and hepatorenal function on
POD was investigated. The evaluation indexes were odds ratios (ORs), relative excess risk due to interaction (RERI), attributable proportion of interaction (AP), and 95% confidence intervals (CIs).
UNASSIGNED: Among the eligible 1,951 patients, 180 had
POD. After adjusting for covariates, higher levels of MBG (OR = 3.703, 95% CI: 1.743-7.870), MAG >0.77 mmol/L/h (OR = 1.754, 95% CI: 1.235-2.490), and GLI >2.6 (mmol/L)2/h/per se (OR = 1.458, 95% CI: 1.033-2.058) were associated with higher odds of POD. The positive associations of MBG, MAG, and GLI with
POD were observed in patients aged <65 years old, male patients, White patients, those with eGFR <60 and INR <1.5, patients with sepsis, and those who received mechanical ventilation and vasopressors (all p < 0.05). Patients with class 3 (OR = 3.465, 95% CI: 1.122-10.696) and class 4 (OR = 3.864, 95% CI: 2.083-7.170) MBG trajectory seemed to have higher odds of
POD, compared to those with a class 1 MBG trajectory. Moreover, MAG (RERI = 0.71, 95% CI: 0.14-1.27, AP = 0.71, 95% CI: 0.12-1.19) and GLI (RERI = 0.78, 95% CI: 0.19-1.39, AP = 0.69, 95% CI: 0.16-1.12) both had a potential synergistic effect with INR on POD.
UNASSIGNED: Focusing on levels of MBG, MAG, GLI, and MBG trajectory may be more beneficial to assess the potential risk of POD than the blood glucose level upon ICU admission in patients with DM undergoing CABG.