Abstract
There is high mortality among intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS) caused by coronavirus disease (COVID-19). Important factors for COVID-19 mortality are diabetes status and elevated fasting plasma glucose (FPG). However, the effect of glycaemic variability on survival has not been explored in patients with COVID-19 and ARDS. This single-centre cohort study compared several metrics of glycaemic variability for goodness-of-fit in patients requiring mechanical ventilation due to COVID-19 ARDS in the ICU at University Hospital Aachen, Germany. 106 patients had moderate to severe ARDS (P/F ratio median [IQR]: 112 [87–148] mmHg). Continuous HRs showed a proportional increase in mortality risk with daily glycaemic variability (DGV). Multivariable unadjusted and adjusted Cox-models showed a statistically significant difference in mortality for DGV (HR: 1.02, (P) < 0.001, LR(P) < 0.001; HR: 1.016, (P) = 0.001, LR(P) < 0.001, respectively). Kaplan–Meier estimators yielded a shorter median survival (25 vs. 87 days) and a higher likelihood of death (75% vs. 31%) in patients with DGV ≥ 25.5 mg/dl (P < 0.0001). High glycaemic variability during ICU admission is associated with significant increase in all-cause mortality for patients admitted with COVID-19 ARDS to the ICU. This effect persisted even after adjustment for clinically predetermined confounders, including diabetes, median procalcitonin and FPG.
【초록키워드】 COVID-19, coronavirus disease, ARDS, Mortality, intensive care, mechanical ventilation, procalcitonin, diabetes, ICU, cohort study, survival, Germany, Patient, ICU admission, death, plasma, university, moderate, Glucose, acute respiratory distress, mortality risk, COVID-19 mortality, Kaplan–Meier estimator, Metrics, Factor, significant increase, severe ARDS, Variability, all-cause mortality, syndrome, statistically significant difference, high mortality, confounders, P/F ratio, likelihood, caused, clinically, elevated, median, adjusted, increase in, diabete, Aachen, Continuous, patients with COVID-19, with COVID-19, 【제목키워드】 ARDS, retrospective, COVID-19 patient, Variability, all-cause mortality,