急性主动脉夹层患者入院时血糖水平与其院内死亡的相关性研究

Study on the Correlation between Blood Glucose Level and Hospital Mortality in Acute Aortic Dissection Patients

背景急性主动脉夹层(AAD)多见危重症,而高血糖是影响危重症患者死亡率的不良因素。目的探讨AAD患者入院时血糖水平与院内死亡率之间的关系。方法回顾性分析2015年1月至2020年8月在河北医科大学第四医院接受手术治疗的非糖尿病AAD患者的病例资料,根据入院时血糖水平分为:高血糖组(>7.8 mmol/L)和正常血糖组(≤7.8 mmol/L)。收集AAD患者基本信息及入院时实验室检查结果,以住院期间全因死亡或术后30 d无终点事件发生为观察终点。采用Cox回归模型分析AAD患者入院时血糖水平与院内死亡的关系,采用Kaplan-Meier方法进行生存曲线分析,绘制受试者工作特征(ROC)曲线评价入院时血糖水平对AAD患者院内死亡的预测价值;采用Cox回归模型分析AAD患者院内死亡的影响因素。结果491例AAD患者中高血糖组165例(33.6%),正常血糖组326例(66.4%)。高血糖组患者院内死亡率较正常血糖组高(19.4%vs 10.4%,χ^(2)=4.172,P=0.006)。在未调整模型中,高血糖组患者院内死亡风险为1.943[95%CI(1.199,3.150),P=0.007];调整年龄、性别后,高血糖组患者院内死亡风险为1.900[95%CI(1.171,3.082),P=0.009];调整年龄、性别、高血压、冠心病、吸烟、Stanford分型、收缩压及舒张压后,高血糖组患者院内死亡风险为1.840[95%CI(1.124,3.010),P=0.015]。入院时血糖预测AAD患者院内死亡的ROC曲线下面积为0.612(0.546,0.696),入院血糖截断值为9.4 mmol/L时,灵敏度为37.9%,特异度为84.9%。经多因素Cox回归模型分析,结果显示,Stanford A型[HR=4.277,95%CI(1.942,9.420),P<0.001]和血糖[HR=1.864,95%CI(1.617,2.113),P=0.007]为AAD患者院内死亡的影响因素。结论入院时血糖水平是AAD患者院内死亡的影响因素,且高血糖水平可能会增加AAD患者院内死亡风险。

Background Acute aortic dissection(AAD)is more common in critically ill patients,and hyperglycemia is an adverse factor affecting the mortality of critically ill patients.Objective To investigate the correlation between admission blood glucose level and in-hospital mortality in patients with AAD.Methods A retrospective analysis of the case data of non-diabetic AAD patients who underwent surgical treatment at the Fourth Hospital of Hebei Medical University from January 2015 to August 2020.According to admission blood glucose level,all cases were divided into:the hyperglycemia group(>7.8 mmol/L)and the normal blood glucose group(≤7.8 mmol/L);Cox proportional hazard modelwas used to evaluate the correlation between admission blood glucose and in-hospital mortality in AAD patients;Kaplan-Meier method was used to analyze the survival curve;ROC analysis was conducted to evaluate the predicting values of admission blood glucose for the inhospital mortality in AAD patients;Cox regression model were performed to determine influencing factors for in-hospital mortality in AAD patients.Results A total of 491 AAD patients were collected including 165(33.6%)cases in the hyperglycemia group and 326(66.4%)cases in the normal blood glucose group.Compared to the normal glucose group,higher in-hospital mortality was found in the hyperglycemia group(19.4%vs 10.4%,χ^(2)=4.172,P=0.006);In the unadjusted Cox model,the relative risk of death in the hyperglycemia group was 1.943[95%CI(1.199,3.150),P=0.007];After adjusting for age and sex in moderately adjusted model,it was 1.900[95%CI(1.171,3.082),P=0.009]in the hyperglycemia group compared with the normal blood glucose group;After adjusting for age,gender,hypertension,coronary heart disease,smoking,Stanford type,systolic blood pressure and diastolic blood pressure,the risk of in-hospital death in the hyperglycemia group was 1.840[95%CI(1.124,3.010),P=0.015].The area under the ROC curve of admission blood glucose for predicting in-hospital death of AAD patients is 0.612(0.546,0.696),when the admission blood glucose cut-off value was 9.4 mmol/L,the sensitivity was 37.9%and the specificity was 84.9%,respectively.The results of multivariate Cox regression model analysis showed that Stanford type A[HR=4.277,95%CI(1.942,9.420),P<0.001]and blood glucose[HR=1.864,95%CI(1.617,2.113),P=0.007]were the influencing factors for in-hospital death in AAD patients.Conclusion The admission blood glucose level is an influencing factor for the in-hospital mortality in AAD patients,and high blood glucose level may increase the risk of in-hospital mortality in AAD patients.