术后血糖变化和切术后死亡率之间的关联:一项回顾性队列研究和死亡率预测模型的开发
Yuanshuo Ge1, Guangdong Wang2, Yun Huang3
1Jinzhou Medical University,The Third Clinical Medical College, Jinzhou, Liaoning, China.
Frontiers in endocrinology
|August 1, 2025
概括
术后的血糖变化 (GV) 预测骨切割后的死亡率. 高GV,通过CV和rMSSD测量,独立增加28天和90天死亡风险,建议其用于神经外科护理.
科学领域:
- 神经外科 神经外科
- 临界护理医学 临界护理医学
- 内分泌学 在内分泌学.
背景情况:
- 血糖变化 (GV) 与危急病患者的不良结果有关.
- 在神经外科患者中,GV的预后价值尚未得到充分确立.
- 这项研究检查了手术后的GV和骨切割后的死亡率.
研究的目的:
- 为了研究术后血糖变异性和骨切割后死亡率之间的关联.
- 评估与传统临床评分相比,GV的预测性能.
- 探索GV-死亡率关系的潜在调解者.
主要方法:
- 对1969名接受头骨手术的成年ICU患者进行了回顾性分析.
- 用变化系数 (CV) 和连续差异的平方根平均值 (rMSSD) 测量GV.
- 多变量考克斯回归,值效应分析,调解分析和随机生存森林 (RSF) 模型与SHAP值.
主要成果:
- 升高的CV和rMSSD独立地与28天和90天死亡率的增加有关.
- 血液尿素 (BUN) 部分调解了GV和死亡率之间的关联.
- 在预测准确性方面,GV指标的表现优于SOFA,GCS和CCI得分 (RSF AUC = 0.841).
结论:
- 术后血糖变异性是切术后死亡率的独立预测因素.
- 在神经外科重症监护中,GV是风险分层的可修改因素.
- 将GV评估纳入临床实践可能会改善患者的治疗结果.
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