应激性血糖升高比值与老年重症肺炎患者谵妄发生的相关性研究

Correlation between stress hyperglycemia ratio and delusion in elderly patients with severe pneumonia

目的探讨应激性血糖升高比值(stress hyperglycemia ratio,SHR)对老年重症肺炎患者谵妄的预测价值及对预后的影响。方法回顾性收集本院重症医学科2020年1月—2024年1月收治的年龄≥60岁的260例重症肺炎患者临床资料。由入院时血糖除以估计的平均血糖计算SHR。记录住院期间谵妄发生情况,谵妄评估使用ICU意识模糊评估法,根据28 d后随访结果分为生存组和死亡组;Spearman秩相关分析SHR与炎症标志物的相关性;ROC曲线评估SHR对谵妄的预测价值,采用Kaplan-Meier生存分析及log-rank检验比较不同SHR组间患者累积生存率的差异。结果260例老年重症肺炎患者中,死亡46例,28 d病死率为17.69%。死亡组谵妄发生率(60.87%)高于生存组(29.91%),差异有统计学意义(P<0.05);死亡组的年龄、APACHEⅡ评分大于生存组,血尿素氮、降钙素原(PCT)、白细胞介素-6(IL-6)、血乳酸(Lac)、SHR均高于生存组,差异有统计学意义(P<0.05)。谵妄发生率为35.38%,谵妄组的28 d病死率(30.43%)高于无谵妄组(10.71%),差异有统计学意义(P<0.05);谵妄组的IL-6、Lac、SHR高于无谵妄组,差异有统计学意义(P<0.05),但两组间PCT、超敏C反应蛋白、糖化血红蛋白差异无统计学意义(P>0.05)。根据SHR四分位数分为4组,SHR≥1.14组的死亡率和谵妄发生率高于其余3组,差异有统计学意义(P<0.001);PCT、IL-6、Lac亦高于其余3组,差异有统计学意义(P<0.001)。SHR与PCT、IL-6、Lac均呈正相关,相关系数r分别为0.210、0.397、0.409(均P<0.05)。SHR预测谵妄发生的曲线下面积为0.720(95%CI:0.659~0.782),当SHR截点是1.07时,灵敏度为80.40%,特异度为53.60%。老年重症肺炎患者Kaplan-Meier生存曲线分析显示,根据SHR四分位数分为的4组间累积生存率差异有统计学意义(χ2=60.093,P<0.001)。结论SHR可用于预测老年重症肺炎患者住院期间谵妄发生,且SHR升高提示预后不良。

Objective To investigate the predictive value of stress hyperglycemia ratio(SHR)on delirium in elderly patients with severe pneumonia and its influence on prognosis.Methods Clinical data of 260 patients aged≥60 years old with severe pneumonia,who were admitted to the Department of Intensive Care Medicine of our hospital from January 2021 to January 2024,were retrospectively collected.SHR was calculated by dividing the blood glucose at admission by the estimated average blood glucose.The occurrence of delirium during hospitalization was recorded.Confusion assessment methods of intensive care Unit(CAM-ICU)was used for delirium assessment,and the patients were divided into survival group and death group according to the follow-up results after 28 days.Spearman rank correlation analysis was performed to examine the correlation between SHR and inflammatory markers.An ROC curve was used to analyze the predictive value of SHR for delirium,Kaplan-Meier survival analyses were generated,and log-rank tests were used to compare differences in cumulative survival among patients in different SHR groups.Results Among 260 elderly patients with severe pneumonia,46 cases died,resulting in a 28-day fatality rate of 17.69%.The incidence of delirium was higher in the death group compared to the survival group(60.87%vs.29.91%,P<0.05).The death group had higher age and acute physiology and chronic health evaluation scores than those in the survival group,as well as elevated levels of BUN,PCT,IL-6,Lac and SHR compared to the survival group(P<0.05).The incidence of delirium was 35.38%,and the 28-day mortality in the delirium group was higher than that in the non-delirium group(30.43%vs.10.71%,P<0.05).IL-6,Lac,and SHR were higher in the delirium group compared to those in non-delirium groups(P<0.05),but there were no significant differences observed between both groups regarding PCT,hs-CRP,and glycated hemoglobin(P>0.05).SHR showed positive correlations with PCT,IL-6,and Lac,with correlation coefficients r of 0.210,0.397,and 0.409 respectively(all P<0.05).The area under the curve(AUC)of SHR for predicting delirium was 0.720(95%CI:0.659-0.782).When the SHR cut-off point was 1.07,the sensitivity was 80.40%and the specificity was 53.60%.Kaplan-Meier survival curve analysis revealed statistically significant differences in cumulative survival rates among elderly patients with severe pneumonia when divided into four groups based on quartiles of SHR values(χ2=60.093,P<0.001).Conclusion SHR can be used to predict the occurrence of delirium in elderly patients with severe pneumonia during hospitalization,and an increase in SHR indicates poor prognosis.