Clinical Study Of Glucose Level And Glucose Variability In Predicting 28-day Prognosis In Adult Patients With Multiple Trauma

Objective: To explore the value of blood glucose level and blood glucose variability in predicting the 28-day survival rate of adult patients with multiple injury,and to establish a model for predicting the poor prognosis of adult patients with multiple injury,so as to provide a basis for the treatment of stress hyperglycemia in adult patients with multiple injury.Methods: This study is a prospective,multicenter,observational clinical study.Patients with multiple injuries admitted to the Affiliated Hospital of Guilin Medical College,the Fifth Affiliated(Zhuhai)Hospital of Zunyi Medical University and the Second Affiliated Hospital of Guilin Medical College from September 2020 to December 2021 were selected.Age,sex,history of primary disease and chronic disease,APACHEII score(Acute Physiology and Chronic Health Evaluation Ⅱ)and SOFA score(Sequential Organ Failure Assessment)were recorded at the time of admission(D0).Venous blood glucose was monitored every 4 hours,and24-hour venous blood glucose was collected.The etiological results,survival and total hospital stay were recorded 28 days after admission(D28)or on the day of withdrawal from the trial.The blood glucose level and blood glucose variability were compared between the survival group and the death group,and the receiver operating characteristic curve(ROC)was used to analyze the value of blood glucose level and blood glucose variability in predicting the prognosis of patients with multiple injuries.Logistics regression analysis was used to establish a prediction model.Result:A total of 257 patients with multiple injuries were collected from September 2020 to December 2021,including 14 patients under 18 years old,35 patients who died within 24 hours and 29 patients who gave up treatment.There were 118 males and 61 females.According to the28-day survival situation,132 patients with multiple injuries were included in the survival group and 47 patients with multiple injuries were included in the death group from September 2020 to December 2021.There was no significant difference in age and sex between the two groups,but the scores of APACHEII and SOFA in the death group were significantly higher than those in the survival group.GLUadm,GLUmax,GLUdif,GLUave,GLUsd,GLUcv and MAGE in the death group were significantly higher than those in the survival group,but there was no significant difference in GLUmin between the two groups.The independent variables of this study were GLUadm,GLUmax,GLUdif,GLUave,GLUsd,GLUcv,MAGE,and the dependent variables were 28-day survival or death.The results of binary logistic regression analysis showed that there were significant differences in APACHEII score,SOFA score,GLUsd and MAGE.The area under ROC curve of APACHE Ⅱ score was 0.835(95%CI:0.766～0.904),the area under ROC curve of SOFA score was 0.918(95%CI:0.878～0.957),the area under GLUsd ROC curve was 0.867(95%CI:0.794～0.940),the area under MAGE ROC curve was 0.620(95%CI:0.523～0.718),and the area under GLUsd curve with SOFA score was0.957(95%CI:0.927～0.988).When the SOFA is 8.50(the optimal critical value),the sensitivity is 93.6% and the specificity is 81.8%;when the GLUsd is 3.3(the optimal critical value),the sensitivity is 76.6% and the specificity is 97%.The results of calculating Youden index showed that the sensitivity and specificity of series test were 100% and 91.7% respectively,and the sensitivity and specificity of parallel test were 61.6% and 98.1% respectively.Conclusions:(1)The initial blood glucose of patients with multiple injuries was higher,and hyperglycemia was significantly related to the increase of mortality.(2)Blood glucose variability is a good indicator of the prognosis of patients with multiple injuries,and hypoglycemia variation has a protective effect and can significantly improve the prognosis of patients with multiple injuries.(3)APACHE Ⅱ score,SOFA score and GV represented by GLUsd and MAGE were independent risk factors for 28-day death in patients with multiple injuries;The combination of SOFA score and GLUsd has more clinical value in comprehensively evaluating the prognosis of patients with multiple injuries.