The prognostic value of blood sugar level for acute respiratory failure patients undergoing mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

BAI Jine ¹ , LIN Xiaoyan ² ,  YANG Rui ³ , LI Ya ⁴

1. Emergency Department, The Affiliated Hospital of Yan’an University, Yan’an, Shan’xi 716000, P.R.China;
2. Hyperbaric Oxygen Department, The Affiliated Hospital of Yan’an University, Yan’an, Shan’xi 716000, P.R.China;
3. Department of Oncology, Yan’an People’s Hospital, Yan’an, Shan’xi 716000, P.R.China;
4. Department of Endocrinology, Affiliated Hospital of Yan’an University, Yan’an, Shan’xi 716000, P.R.China;

Corresponding author：

YANG Rui, Email: 303163116@qq.com

Keywords：

Acute respiratory failure; Mechanical ventilation; Blood glucose; Prognosis

DOI：

10.7507/1671-6205.201609050

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Objectives To assess the prognostic value of blood sugar level for acute respiratory failure patients undergoing mechanical ventilation. Methods The study collected 139 acute respiratory failure patients undergoing mechanical ventilation admitted between February 2012 and October 2013. The patients were divided into a hyperglycemic group (n=123, blood sugar ≥143 mg/dl) and a non-hyperglycemic group (n=16, blood sugar <143 mg/dl). The data for basic clinical pathological characteristics and the blood sugar levels were collected, and the correlation between the blood sugar level and the prognosis was assessed using single factor analysis and logistic regression method. Results In the study, 88.49% of patients with acute respiratory failure undergoing mechanical ventilation had hyperglycemia (blood sugar ≥143 mg/dl). The proportions of patients with APACHEⅡ score ≥10, chronic obstructive pulmonary disease (COPD) or hypoxemia in the hyperglycemic group were significantly higher than those in the non-hyperglycemic group (P<0.05). APACHEⅡ ≥10, COPD and hypoxemia were significant risk factors for hyperglycemia. At the same time, the proportions of patients in the death group with hyperglycemia ≥143 mg/dl ( OR=8.354, 95%CI 1.067-65.388, P=0.018), APACHEⅡ≥10 ( OR=2.545, 95%CI 1.109-6.356, P=0.046), COPD ( OR=2.871, 95%CI 1.203-6.852, P=0.015), and hypoxemia ( OR=3.500, 95%CI 1.556-7.874, P=0.002) were significantly higher than those in the survival group. Kaplan-Meier curve analysis found that the overall survival of the hyperglycemic patients with acute respiratory failure was significantly lower than that in the non-hyperglycemic patients (P<0.001). Conclusion Blood sugar level can be used as an independent predictor for acute respiratory failure patients undergoing mechanical ventilation.

Citation： BAI Jine, LIN Xiaoyan, YANG Rui, LI Ya. The prognostic value of blood sugar level for acute respiratory failure patients undergoing mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(4): 371-374. doi: 10.7507/1671-6205.201609050 Copy

1.	谷伟, 孙丽华, 乔岩. 非侵入性通气治疗慢性阻塞性肺疾病合并呼吸衰竭的进展. 中国呼吸与危重监护杂志, 2003, 2(4): 243-245.
2.	Finfer S, Heritier S. The NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation) Study: statistical analysis plan. Crit Care Resusc, 2009, 11(1): 46-57.
3.	Bagshaw SM, Egi M, George C, et al. Early blood glucose control and mortality in critically ill patients in Australia. Crit Care Med, 2009, 37(2): 463-470.
4.	Chase JG, Pretty CG, Pfeifer L, et al. Organ failure and tight glycemic control in the SPRINT study. Crit Care, 2010, 14(4): R154.
5.	李坚, 张德厚, 孙丽萍, 等. 无创正压通气救治慢性阻塞性肺疾病呼吸衰竭后期失败的相关因素分析. 中国呼吸与危重监护杂志, 2003, 2(2): 100-103.
6.	Breyer MK, Rutten EPA, Locantore NW, et al. Dysregulated adipokine metabolism in chronic obstructive pulmonary disease. Eur J Clin Invest, 2012, 42(9): 983-991.
7.	陈灏珠, 主编. 内科学. 第4版. 北京: 人民卫生出版社, 1996, 44-45.
8.	李飞, 于洪涛, 王婷. 呼吸重症监护病房有创机械通气患者血糖最佳控制水平的临床研究. 中国急救医学, 2016, 36(2): 134-138.
9.	姜鹤, 乔洁, 陈名道. 危重患者的胰岛素强化治疗: NICE-SUGAR 或 Leuven, 血糖控制目标何去何从?. 中华内分泌代谢杂志, 2010, 26(1): 66-69.
10.	Targher G, Dauriz M, Tavazzi L, et al. Prognostic impact of in-hospital hyperglycemia in hospitalized patients with acute heart failure: Results of the IN-HF (Italian Network on Heart Failure) Outcome registry. Int J Cardiol, 2015, 203: 587-593.
11.	Van den Berghe G. Intensive insulin therapy in the ICU--reconciling the evidence. Nat Rev Endocrinol, 2012, 8(6): 374-378.
12.	Mcguinness OP. Defective glucose homeostasis during infection. Annu Rev Nutr, 2005, 25: 9-35.
13.	Islam EA, Limsuwat C, Nantsupawat T, et al. The association between glucose levels and hospital outcomes in patients with acute exacerbations of chronic obstructive pulmonary disease. Ann Thorac Med, 2015, 10(2): 94-99.
14.	滕丽华, 王仲. 急性呼吸窘迫综合征预后评估研究进展. 临床急诊杂志, 2015, 16(4): 323-326.
15.	Pallayova M, Lazurova I, Donic V. Hypoxic damage to pancreatic beta cells--the hidden link between sleep apnea and diabetes. Med Hypotheses, 2011, 77(5): 930-934.
16.	Donati A, Damiani E, Domizi R, et al. Glycaemic variability, infections and mortality in a medical-surgical intensive care unit. Crit Care Resusc, 2014, 16(1): 13-23.

1. 谷伟, 孙丽华, 乔岩. 非侵入性通气治疗慢性阻塞性肺疾病合并呼吸衰竭的进展. 中国呼吸与危重监护杂志, 2003, 2(4): 243-245.
2. Finfer S, Heritier S. The NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation) Study: statistical analysis plan. Crit Care Resusc, 2009, 11(1): 46-57.
3. Bagshaw SM, Egi M, George C, et al. Early blood glucose control and mortality in critically ill patients in Australia. Crit Care Med, 2009, 37(2): 463-470.
4. Chase JG, Pretty CG, Pfeifer L, et al. Organ failure and tight glycemic control in the SPRINT study. Crit Care, 2010, 14(4): R154.
5. 李坚, 张德厚, 孙丽萍, 等. 无创正压通气救治慢性阻塞性肺疾病呼吸衰竭后期失败的相关因素分析. 中国呼吸与危重监护杂志, 2003, 2(2): 100-103.
6. Breyer MK, Rutten EPA, Locantore NW, et al. Dysregulated adipokine metabolism in chronic obstructive pulmonary disease. Eur J Clin Invest, 2012, 42(9): 983-991.
7. 陈灏珠, 主编. 内科学. 第4版. 北京: 人民卫生出版社, 1996, 44-45.
8. 李飞, 于洪涛, 王婷. 呼吸重症监护病房有创机械通气患者血糖最佳控制水平的临床研究. 中国急救医学, 2016, 36(2): 134-138.
9. 姜鹤, 乔洁, 陈名道. 危重患者的胰岛素强化治疗: NICE-SUGAR 或 Leuven, 血糖控制目标何去何从?. 中华内分泌代谢杂志, 2010, 26(1): 66-69.
10. Targher G, Dauriz M, Tavazzi L, et al. Prognostic impact of in-hospital hyperglycemia in hospitalized patients with acute heart failure: Results of the IN-HF (Italian Network on Heart Failure) Outcome registry. Int J Cardiol, 2015, 203: 587-593.
11. Van den Berghe G. Intensive insulin therapy in the ICU--reconciling the evidence. Nat Rev Endocrinol, 2012, 8(6): 374-378.
12. Mcguinness OP. Defective glucose homeostasis during infection. Annu Rev Nutr, 2005, 25: 9-35.
13. Islam EA, Limsuwat C, Nantsupawat T, et al. The association between glucose levels and hospital outcomes in patients with acute exacerbations of chronic obstructive pulmonary disease. Ann Thorac Med, 2015, 10(2): 94-99.
14. 滕丽华, 王仲. 急性呼吸窘迫综合征预后评估研究进展. 临床急诊杂志, 2015, 16(4): 323-326.
15. Pallayova M, Lazurova I, Donic V. Hypoxic damage to pancreatic beta cells--the hidden link between sleep apnea and diabetes. Med Hypotheses, 2011, 77(5): 930-934.
16. Donati A, Damiani E, Domizi R, et al. Glycaemic variability, infections and mortality in a medical-surgical intensive care unit. Crit Care Resusc, 2014, 16(1): 13-23.

Chinese Journal of Respiratory and Critical Care Medicine

The prognostic value of blood sugar level for acute respiratory failure patients undergoing mechanical ventilation

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