Relationship Between Indexes Related To Blood Glucose And Prognosis In Critically Ill Patients

Objective: To analyze the correlation between mean blood glucose as well as variability of blood glucose and prognosis of critically ill patients and to control the mean blood glucose and variability of blood glucose in a relatively reasonable range to guide the reasonable control of blood glucose of critically ill patients.Methods: The study was an observational study.The patients admitted to Guizhou Medical University from January 2016 to December 2016,who met the inclusion and exclusion criteria,were selected as study objects.The following statistical analysis was conducted according to different indexes.First,according to the prognosis after 28 d,the patients were divided into the survival and dead group,general clinical data and differences in blood glucose-related indexes were compared between the two groups.Second,the sensitivity curve(ROC curve)was applied to evaluate the APACHE II score and the value of blood glucose-related indexes after28 d prognosis.Third,the variability of blood glucose index—glycemic lability index(GLI)was counted.The patients were divided into four groups according to the quartile of GLI as follows(1.09?6.66?13.58?26.49?206.00).G1 group: GLI ranged from 0% to 25%(1.09(mmol/L)2/h/d?GLI?6.66(mmol/L)2/h/d).G2 group: GLI ranged from 26% to 50%(6.66(mmol/L)2/h/d<GLI?13.58(mmol/L)2/h/d).G3 group: GLI ranged from51% to 75%(13.58(mmol/L)2/h/d<GLI?26.49(mmol/L)2/h/d).G4 group:GLI ranged from 76% to 100%(26.4(mmol/L)2/h/d9<GLI?206.00(mmol/L)2/h/d).Respectively compare the differences in APACHE II score,BGmean,28 d mortality,the time in ICU as well as the use of ventilator of patients in four groups.Fourth,the BGmean,7.8mmol/L,10.0mmol/L was set as the boundary value and the patients were divided into three groups,namely Q1 group: BGmean> 10.0mmol/L,Q2 group:7.8 mmol/L?BGmean ? 10.0 mmol/L,Q5 group: BGmean <7.8mmol/L.Respectively compare the differences in 28 d mortality,general clinical data as well as thevariability of blood glucose index of patients in three groups.Fifth,the median BGmean was set as the boundary value and BGmean was divided into the high BGmean group(BGmean>median)and the low BGmean group(BGmean ?median).Meanwhile,the median GLI was set as the boundary value and GLI was divided into the high GLI group(GLI>median)and the low GLI group(GLI ?median).Combined with the above both two indexes,the patients who met low BGmean and low GLI at the same time were recorded as the low BGmean + low GLI group;the patients who met high BGmean and low GLI at the same time were recoded as the the high BGmean + low GLI group;the patients who met low BGmean and high GLI at the same time were recoded as the the low BGmean + high GLI group;the patients who met high BGmean and high GLI at the same time were recoded as the the high BGmean + high GLI group.Respectively compare differences in general clinical data and short-term mortality of patients in above four groups.Results:(1)The APACHE II score,service time of ventilator,BGmean,GLI,blood glucose standard deviation(BGSD),blood glucose coefficient of variation(BGCV),the change of mean absolute glucose(MAG)of the patients in the dead group were higher than that of the survival group.There existed significant statistical difference(P <0.05).There was no significant difference in age and the time in ICU between the two groups(P>0.05).(2)For the judgement value of APACHE II value,BGmean,BGSD?BGCV,GLI,MAG for the 28 d mortality of the critically ill patients,the area under the ROC curve was respectively 0.627,0.677,0.780,0.758,0.806,0.799.(3)For the patients who were divided into four groups according to the quartile of GLI,it's showed that the BGmean of the G1 group was the lowest,while the G4 group was the highest.There existed significant difference(P<0.05).There was no significant difference in the time in ICU among the four groups(P>0.05).The patients in the G4 group used the ventilator for the longest time,but there was no significant difference among another three groups(P>0.05).The 28 d mortality of the G4 group was the highest,but there was no significant difference between G1 and G2 group,G2 and G3 group(P>0.05).There was no significant difference in 28 d mortality between the G1 and the G3 group(P<0.05).(4)The patients were divided into three groups according to BGmean,7.8mmol/L and 10.0mmol/L.There existed significant statistical difference in BGmean,BGSD,BGCV,GLI,MAG and service time of ventilator between Q1 and Q2group(P<0.05).There was no significant difference in other indexes between the two groups(P>0.05).There was significant difference in BGmean between the the Q2 and Q3 group(P<0.05),but there was no significant difference in other indexes between the two groups(P> 0.05).There was significant difference in age,BGSD,GLI,MAG,as well as service time of ventilator between Q2 and Q3 group(P<0.05),but there was no significant difference in other indexes(P>0.05).(5)According to the BGmean(9.88mmol/L)and the median GLI(13.58(mmol/L)2/h/d),the patients were divided into four groups.The 28 d mortality of the low BGmean + high GLI group was higher than that of the low BGmean + Low GLI group and there was significant statistical difference(P<0.05).The 28 d mortality of the high BGmean + high GLI group was higher than that of the high BGmean + Low GLI group and there was significant statistical difference(P<0.05),while there was no significant statistical difference in28 d mortality between the low BGmean + low GLI group and the high BGmean +high GLI group,as well as the low BGmean + high GLI group and the high BGmean+ high GLI group(P>0.05).Conclusion: Blood glucose variability is associated with prognosis in critically ill patients,The value of GLI is superior to other variability of blood glucose indexes in assessing the condition of critically ill patients and predicting the short-term prognosis.Controlling GLI in critically ill patients can improve patient outcomes.Controlling GLI of the critically ill patients below the level of 13.58(mmol/L)2/h/d which may be a relatively reasonable level.Controlling the blood glucose at the level of 7.8~10.0mmol/L which may be a relative reasonable range.Severe blood glucose variability is more harmful to the body of patients with severe than hyperglycemia.