The complexity of glucose time series is associated with short- and long-term mortality in critically ill adults: a multi-center, prospective, observational study.

IF 5.4 2区 医学 Q1 Medicine Journal of Endocrinological Investigation Pub Date : 2024-12-01 Epub Date: 2024-05-18 DOI:10.1007/s40618-024-02393-4
Y Wang, S Li, J Lu, K Feng, X Huang, F Hu, M Sun, Y Zou, Y Li, W Huang, J Zhou
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Abstract

Background: The wealth of data taken from continuous glucose monitoring (CGM) remains to be fully used. We aimed to evaluate the relationship between a promising new CGM metric, complexity of glucose time series index (CGI), and mortality in critically ill patients.

Methods: A total of 293 patients admitted to mixed medical/surgical intensive care units from 5 medical centers in Shanghai were prospectively included between May 2020 and November 2021. CGI was assessed using intermittently scanned CGM, with a median monitoring period of 12.0 days. Outcome measures included short- and long-term mortality.

Results: During a median follow-up period of 1.7 years, a total of 139 (47.4%) deaths were identified, of which 73 (24.9%) occurred within the first 30 days after ICU admission, and 103 (35.2%) within 90 days. The multivariable-adjusted HRs for 30-day mortality across ascending tertiles of CGI were 1.00 (reference), 0.68 (95% CI 0.38-1.22) and 0.36 (95% CI 0.19-0.70), respectively. For per 1-SD increase in CGI, the risk of 30-day mortality was decreased by 51% (HR 0.49, 95% CI 0.35-0.69). Further adjustment for HbA1c, mean glucose during hospitalization and glucose variability partially attenuated these associations, although the link between CGI and 30-day mortality remained significant (per 1-SD increase: HR 0.57, 95% CI 0.40-0.83). Similar results were observed when 90-day mortality was considered as the outcome. Furthermore, CGI was also significantly and independently associated with long-term mortality (per 1-SD increase: HR 0.77, 95% CI 0.61-0.97).

Conclusions: In critically ill patients, CGI is significantly associated with short- and long-term mortality.

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葡萄糖时间序列的复杂性与重症成人的短期和长期死亡率相关:一项多中心、前瞻性观察研究。
背景:从连续血糖监测(CGM)中获取的大量数据仍有待充分利用。我们旨在评估一种有前景的新 CGM 指标--血糖时间序列复杂性指数(CGI)--与重症患者死亡率之间的关系:2020年5月至2021年11月期间,上海5家医疗中心共纳入了293名内外科混合重症监护病房的患者。使用间歇性扫描 CGM 评估 CGI,中位监测期为 12.0 天。结果测量包括短期和长期死亡率:中位随访期为 1.7 年,共发现 139 例(47.4%)死亡病例,其中 73 例(24.9%)发生在入住 ICU 后的前 30 天内,103 例(35.2%)发生在 90 天内。经多变量调整后,各CGI递增分层的30天死亡率HR分别为1.00(参考值)、0.68(95% CI 0.38-1.22)和0.36(95% CI 0.19-0.70)。CGI每增加1分,30天死亡风险降低51%(HR 0.49,95% CI 0.35-0.69)。对 HbA1c、住院期间平均血糖和血糖变异性的进一步调整部分削弱了这些关联,但 CGI 与 30 天死亡率之间的联系仍然显著(每增加 1 个标准差:HR 0.57,95% CI 0.40-0.83)。将 90 天死亡率作为结果时,也观察到了类似的结果。此外,CGI 与长期死亡率也有显著的独立相关性(每增加 1SD:HR 0.77,95% CI 0.61-0.97):结论:在重症患者中,CGI 与短期和长期死亡率有显著相关性。
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来源期刊
Journal of Endocrinological Investigation
Journal of Endocrinological Investigation ENDOCRINOLOGY & METABOLISM-
CiteScore
8.10
自引率
7.40%
发文量
242
期刊介绍: The Journal of Endocrinological Investigation is a well-established, e-only endocrine journal founded 36 years ago in 1978. It is the official journal of the Italian Society of Endocrinology (SIE), established in 1964. Other Italian societies in the endocrinology and metabolism field are affiliated to the journal: Italian Society of Andrology and Sexual Medicine, Italian Society of Obesity, Italian Society of Pediatric Endocrinology and Diabetology, Clinical Endocrinologists’ Association, Thyroid Association, Endocrine Surgical Units Association, Italian Society of Pharmacology.
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