目标血糖范围中的时间与心力衰竭重症患者全因死亡率之间的关联
1Southeast University Affiliated Xuzhou Central Hospital, Xuzhou, China; Department of Endocrinology, Beijing Tsinghua Changgung Hospital, Beijing, China.
概括
目标血糖范围 (TTBR) 的较长时间与重症监护室心力衰竭患者的死亡率降低有关. 这一发现强调了TTBR作为血糖控制和患者结果的关键指标.
科学领域:
- 关键护理医学 关键护理医学
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
背景情况:
- 在ICU中的心力衰竭 (HF) 患者面临高死亡率.
- 血糖失调经常使HF患者的危急疾病复杂化.
- 目标血糖范围中的时间 (TTBR) 是一个全面的血糖控制指标,但其在重症肝炎患者的预后价值尚未确立.
研究的目的:
- 调查TTBR与心力衰竭重症患者的死亡率之间的关联.
- 评估TTBR作为高风险人群中血糖控制的潜在预后指标.
主要方法:
- 来自MIMIC-IV数据库的5396名危急性HF患者的回顾性队列研究.
- 计算TTBR是根据百分比的时间葡萄糖水平在70-139 mg/dL之间.
- 考克斯比例危险回归和受限立方线分析了TTBR和死亡率之间的关联,并进行了子组分析.
主要成果:
- 随着TTBR四分位数的增加,死亡率逐渐下降 (Q1:20.83%到Q4:8.9%).
- 较高的TTBR独立地与显著降低的死亡风险相关 (连续HR0.98,Q4与Q1HR0.58).
- 使用TTBR的死亡率预测模型显示出良好的区分能力 (AUC 0.77).
结论:
- 较高的TTBR独立地与严重心力衰竭患者的较低死亡率有关.
- 在HF患者的ICU环境中,TTBR显示出作为血糖控制的有价值的预后指标的潜力.
相关概念视频
01:15Hypoglycemia and Glucagon
335
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
335
01:15Diabetes: Symptoms, Diagnosis, and Complications
692
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
692
01:30Heart Failure V: Medical Management
23
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
23
01:22Heart Failure VI: Adjunct Therapies
27
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
27
01:15Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
124
Circadian rhythms are cyclic changes that are crucial in plasma drug concentrations. Various standard circadian parameters, including core body temperature, heart rate, and other cardiovascular factors, directly impact disease states and the therapeutic response to drug therapy.
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
124
01:30Heart Failure VII: Nursing Interventions
139
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
139