Prognostic value of early glycemic lability index in patients with out-of-hospital cardiac arrest
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摘要: 目的 分析院外心脏骤停(out-of-hospital cardiac arrest，OHCA)患者早期血糖波动对预后的评估价值。方法 选取进入徐州医科大学附属医院符合标准的OHCA患者102例，每隔2 h一次，监测自主循环恢复(return of spontaneous circulation，ROSC)后入住ICU 24 h内的血糖值，根据公式得出血糖不稳定指数(glucose lability index，GLI)。根据患者28 d预后将其分为存活组和死亡组，比较2组患者一般资料及GLI的差异；根据GLI水平按照三分位数将患者分为3组(GLI 1组，GLI 2组，GLI 3组)，比较各组患者28 d预后的差异；分析GLI和APACHE Ⅱ评分的相关性；绘制受试者工作特征(receiver operating characteristic，ROC)曲线评估GLI和APACHE Ⅱ评分对患者28 d预后的预测价值。结果 死亡组早期GLI、APACHE Ⅱ评分均大于存活组(P < 0.001)；与GLI 1组相比，GLI 2组和GLI 3组28 d预后更差，APACHE Ⅱ评分更高(均P < 0.05)；Spearman相关性分析显示GLI与APACHE Ⅱ呈正相关(r=0.300，P=0.002)；二元logistic回归分析显示，较高的GLI(P=0.001)和较高的APACHE Ⅱ评分(P < 0.001)是OHCA患者预后差的独立危险因素。ROC曲线显示GLI和APACHE Ⅱ评分预测OHCA患者预后的曲线下面积(area under the curve，AUC)分别为0.810和0.802(P < 0.001)。结论 早期GLI可用于OHCA患者的28 d预后评估，早期积极控制血糖波动可能有利于改善患者的预后。Abstract: Objective To analyze the prognostic value of early blood glucose fluctuation in patients with out of hospital cardiac arrest(OHCA).Methods A total of 102 out-of-hospital cardiac arrest patients who entered Affiliated Hospital of Xuzhou Medical University and met the standards were selected, and the blood glucose values within 24 hours after admission to ICU after the return of spontaneous circulation(ROSC) were monitored every 2 hours. The blood glucose instability index(GLI) was obtained according to the formula. Patients were divided into survival group and death group according to their 28-day prognosis, compare the difference of general information and GLI between the two groups; Patients were divided into three groups(GLI 1, GLI 2, GLI 3) based on the GLI level according to the three quantiles, to compare the difference of 28-day prognosis in each group; Analyze the correlation between GLI and acute physiology and chronic health assessment(APACHE Ⅱ) scores; ROC curve was drawn to evaluate the predictive value of GLI and APACHE Ⅱ scores on the 28-day prognosis of patients.Results The scores of early GLI and APACHE Ⅱ in death group were higher than those in survival group(P < 0.001); Compared with GLI 1 group, GLI 2 group(P < 0.05) and GLI 3 group(P < 0.01) had worse 28-day prognosis and higher APACHE Ⅱ score; Spearman correlation analysis showed that GLI was positively correlated with APACHE Ⅱ(r=0.300, P=0.002); Binary logistic regression analysis showed that higher GLI(P=0.001) and higher APACHE Ⅱ score(P < 0.001) were independent risk factors for poor prognosis of OHCA patients. ROC curve showed that the area under the curve(AUC) predicted by GLI and APACHE Ⅱ scores for the prognosis of OHCA patients were 0.810 and 0.802, respectively(P < 0.001).Conclusion Early GLI can be used to evaluate the 28-day prognosis of OHCA patients, and early active control of blood glucose fluctuations may be helpful to improve the prognosis of patients.
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Key words:
- out-of-hospital cardiac arrest /
- glucose variability /
- glucose lability index /
- prognosis
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表 1 存活组和死亡组一般临床基线资料比较
例(%) 基线资料 存活组(n=44) 死亡组(n=58) P 年龄/岁 56(40，71) 63(49，68) 0.378 性别 0.244 男 23 37 女 21 21 高血压 23(52.27) 24(41.38) 0.277 糖尿病 13(29.55) 14(24.14) 0.542 吸烟 12(27.27) 19(32.76) 0.553 饮酒 13(29.55) 14(24.14) 0.557 CA病因 心血管系统 21(47.73) 16(27.59) 0.036 呼吸系统 3(6.82) 13(22.41) 0.061 神经系统 7(15.91) 18(31.03) 0.079 代谢 5(11.36) 1(1.72) 0.104 其他 8(18.18) 10(17.24) 0.902 CPR持续时间/min 10(8.5，11.5) 10(5，15) 0.445 机械通气时间/d 4.5(1.0，10.5) 3(2，7) 0.394 APACHE Ⅱ评分/分 19(15，24) 28(21，34) < 0.001 GLI/[(mmol/L)2/h] 17.76(12.88，24.72) 77.46(39.41，109.97) < 0.001 住院天数/d 20(10，33) 3(2，6) < 0.001 
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表 2 不同GLI组的组间资料比较
M(P25，P75) 组间资料 GLI 1组 GLI 2组 GLI 3组 P 28 d病死率/% 20.59 61.761) 88.241) < 0.001 入住ICU时间/d 11(5，20) 5(3，15) 2(1，5)1)2) 0.001 机械通气时间/d 4(1，10) 5(3，11) 2(1，5) 0.088 APACHE Ⅱ评分/分 19(15，25) 25(19，33)1) 28(20，34)1) < 0.001 与GLI 1组比较，1) P < 0.05；与GLI 2组比较，2) P < 0.05。
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表 3 不同GLI组有无糖尿病患者之间28 d病死率的比较
组别 例数 28 d病死率/% GLI 1组 34 有糖尿病 8 37.50 无糖尿病 26 15.38 GLI 2组 34 有糖尿病 5 80.00 无糖尿病 29 58.62 GLI 3组 34 有糖尿病 14 92.86 无糖尿病 20 85.00
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