Short-term intensive glucose control in patients with severe acute pancreatitis
- Author:
- No author available
- Journal Title:
- Chinese Critical Care Medicine
- Issue:
- 1
- DOI:
- 10.3760/cma.j.issn.1003-0603.2012.01.006
- Key Word:
- 胰腺炎,急性;血糖控制;血糖变异性;重症监护;Acute pancreatitis;Glucose control;Glucose variability;Intensive care
Abstract： Objective To investigate effects of intensive glucose control (IGC) on glucose variability (GV)and clinical outcomes in patients with severe acute pancreatitis (SAP),and to assess predictive values of different measures of GV on intensive care unit (ICU) death.Methods A prospective,randonized,non-blinded clinical trial was conducted.All adult patients with diagnosis of SAP,who were admitted to ICU of West China Hospital between July 1st 2010 and July 1st 2011,were enrolled.Eligible patients were randomly assigned to receive either IGC to maintain glucose level between 6.1 mmol/L and 8.3 mmol/L or control group (none intervention was given).GV,ICU mortality,the incidence of infection,length of mechanical ventilation and ICU stay of the two groups were compared.The standard deviation of blood glucose level (GLUSD),mean amplitude of glycemic excursion (GLUMAGE) and glycemic lability index (GLUGLI) were chosen as measures of GV to analyze the multi variable correlation between them and ICU mortality,and the ability of these three parameters was assessed in predicting ICU death using area under a receiver operating characteristic curve (AUC).Results One hundred and twenty-two patients were eligible for the study,and 30 patients with SAP were enrolled in the study,with 15 cases in each group.The basic data of the two groups were comparable.Compared with control group,IGC showed an effect to reduce GV,including GLUSD [mmol/L: 1.81 (0.97,2.65 ) vs.2.48 ( 1.29,2.87 ) ],GLUMAGE [ mmol/L: 3.76 (3.67,5.85 ) vs.5.30 (4.35,6.80) ],GLUGLI [ 306.8 (220.6,613.3 ) vs.339.5 (218.4,423.1 )],and lower ICU mortality (13.3％ vs.40.0％ ),but the difference showed no significant difference (all P＞0.05).It could also shorten the length of ICU stay (days: 11.3±9.9 vs.15.8 ±7.6,P＜0.01),decrease the incidence of infection of blood stream and the lung (6.7％ vs.40.0％; 33.3％ vs.73.3％,both P＜0.05 ).A possitive correlation between GLUGLU and ICU mortality was found (r=0.371,P=0.044),but no correlation was found between GLUsD or GLUMAGE and ICU mortality (rvalue was -0.144 and -0.065,P value was 0.448 and 0.731 ).AUC for GLUSD,GLUMAGE and GLUGLI was 0.594 [95％ confidence interval (95％ CI) 0.382-0.805],0.543 (95％ CI 0.287-0.798) and 0.751 (95％ CI 0.548-0.954) respectively,and GLUGLI was the best predictor of ICU death.Conclusions IGC had an effect to reduce GV,decrease ICU mortality,shorten length of ICU stay,and lower the incidence of infection.Compared with GLUSD and GLUMAGE,GLUGLI was the best predictor of ICU death.
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