Importancia pronóstica de la variabilidad glucémica sobre la mortalidad intrahospitalaria en pacientes ingresados en Medicina Interna

Sáenz-Abad, D. (Universidad de Zaragoza) ; Gimeno-Orna, J. ; Pérez-Calvo, J. I. (Universidad de Zaragoza)

Resumen: Introduction The objective was to assess the prognostic importance of various glycaemic control measures on hospital mortality. Material and methods Retrospective, analytical cohort study that included patients hospitalised in internal medicine departments with a diagnosis related to diabetes mellitus (DM), excluding acute decompensations. The clinical endpoint was hospital mortality. We recorded clinical, analytical and glycaemic control-related variables (scheduled insulin administration, plasma glycaemia at admission, HbA1c, mean glycaemia (MG) and in-hospital glycaemic variability and hypoglycaemia). The measurement of hospital mortality predictors was performed using univariate and multivariate logistic regression. Results A total of 384 patients (50.3% men) were included. The mean age was 78.5 (SD, 10.3) years. The DM-related diagnoses were type 2 diabetes (83.6%) and stress hyperglycaemia (6.8%). Thirty-one (8.1%) patients died while in hospital. In the multivariate analysis, the best model for predicting mortality (R2 = 0.326; P<.0001) consisted, in order of importance, of age (¿2 = 8.19; OR = 1.094; 95% CI 1.020-1.174; P=.004), Charlson index (¿2 = 7.28; OR = 1.48; 95% CI 1.11-1.99; P=.007), initial glycaemia (¿2 = 6.05; OR = 1.007; 95% CI 1.001-1.014; P=.014), HbA1c (¿2 = 5.76; OR = 0.59; 95% CI 0.33-1; P=.016), glycaemic variability (¿2 = 4.41; OR = 1.031; 95% CI 1-1.062; P=.036), need for corticosteroid treatment (¿2 = 4.03; OR = 3.1; 95% CI 1-9.64; P=.045), administration of scheduled insulin (¿2 = 3.98; OR = 0.26; 95% CI 0.066-1; P=.046) and systolic blood pressure (¿2 = 2.92; OR = 0.985; 95% CI 0.97-1.003; P=.088). Conclusion An increase in initial glycaemia and in-hospital glycaemic variability predict the risk of mortality for hospitalised patients with DM.

Idioma: Español

DOI: 10.1016/j.rce.2015.06.003

Año: 2015

Publicado en: Revista Clínica Española 215, 9 (2015), 479-485
ISSN: 0014-2565

Factor impacto JCR: 0.76 (2015)

Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 105 / 153 = 0.686 (2015) - Q3 - T3

Factor impacto SCIMAGO: 0.186 - Medicine (miscellaneous) (Q3)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)