ICU应激性高血糖患者危险因素模式的潜在类别及与预后的关系

Latent class analysis patterns of risk factors for stress-induced hyperglycemia among ICU patients and their association with prognosis

目的了解ICU应激性高血糖患者危险因素模式的潜在类别,并探讨与预后的关系,为改善患者生存结局提供参考。方法回顾性选取急诊ICU住院的应激性高血糖患者为研究对象。收集人口学、疾病相关资料及28 d内死亡和院内死亡情况。采用潜在类别分析将ICU应激性高血糖患者的危险因素模式进行归类,通过logistic回归分析不同危险因素模式与预后结局的关系。结果共纳入621例ICU应激性高血糖患者,其中院内死亡38例(6.1%),28 d内死亡54例(8.7%)。基于潜在类别分析将其分为血糖稳定-低危(26.9%)、血糖波动-治疗(27.4%)、老年共病(21.6%)、高危感染(24.1%)4种危险因素模式;血糖波动-治疗模式、老年共病模式、高危感染模式的患者28 d内死亡风险和院内死亡风险显著高于血糖稳定-低危模式(均P<0.05)。结论ICU应激性高血糖患者危险因素模式存在异质性,医护人员应提高对高危感染模式、老年共病模式和血糖波动-治疗模式应激性高血糖患者的关注度,通过识别危险因素模式的潜在类型给予针对性的干预措施,改善不良预后。

Objective To identify the latent class analysis patterns of risk factor for stress-induced hyperglycemia(SIH)among ICU patients and explore their association with prognosis,aiming to provide reference for improving patient survival outcomes.Methods This retrospective study included patients with SIH admitted to the emergency ICU.Demographic,disease-related data,in-hospital mortality and 28-day mortality were collected.Latent class analysis was used to identify the risk factor patterns,and logistic regression was employed to analyze the association between different risk factor patterns and patient outcomes.Results A total of 621 patients were included,among whom 38(6.1%)died in the hospital and 54(8.7%)died within 28 days.Latent class analysis identified four risk factor patterns:stable glucose with low-risk(26.9%),fluctuating glucose with insulin treatment(27.4%),older age with comorbidities(21.6%),and high-risk infection(24.1%).Patients in the fluctuating glucose with insulin treatment,older age with comorbidities,and high-risk infection patterns had significantly higher risks of in-hospital mortality and 28-day mortality compared with those in the stable glucose with low-risk pattern(all P<0.05).Conclusion There is heterogeneity in the risk factor patterns among ICU patients with SIH.Healthcare professionals should pay attention to patients in the high-risk infection pattern,older age with comorbidities pattern and the fluctuating glucose with insulin treatment pattern,and provide targeted interventions by identifying potential risk factor pattern to improve their overall prognosis.