A clinical study of the predictive value in blood glucose concentration and blood glucose variability to 28-day survival rate in adults with complicated intra-abdominal infection after surgical operation

LI Xiao-yue; SHEN Li-han; CAI Li-hua

doi:10.3969/j.issn.1002-1949.2014.08.007

Abstract：Objective To investigate the predictive value in blood glucose concentration and blood glucose variability to 28-day survival rate in adults with complicated intra -abdominal infection after surgical operation .Methods A prospective study was conducted .Blood glucose monitoring and prognosis observation were performed for the adult non -diabetic patients with complicated intra -abdominal infection admitted in ICU from July 2012 to September 2013 .Blood monitoring terminal was 24 hours after admitted in ICU .Prognosis observation terminal was 28 days after admitted in ICU .The blood glucose concentration admitted in ICU , the maximum and minimum values of blood glucose were recorded.Acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) scores, sequential organ failure assessment ( SOFA) , differential value of blood glucose ( GLUdif ) , average value of blood glucose (GLUave) and standard deviation (GLUsd), coefficient of blood glucose (GLUcv), mean absolute blood glucose fluctuation amplitude ( MAGE) were calculated .Patients were divided into survival group and non-survival group .Results Sixty -eight patients were divided into survival group ( n =54 ) and non-survival group ( n=35).There were no significantly differences in age , sex, primary disease, blood glucose concentration on admission , acute physiology and chronic health evaluation and sequential organ failure assessment between two groups (P>0.05).GLUmax, GLUdif, MAGE in survival group were significantly lower than those in non -survival group (P<0.05).Area under ROC of MAGE, GLUmax and GLUdif were 0.806, 0.787 and 0.769, respectively.With a cut-off value of 15.4 mmol/L, GLUmax had a sensitivity of 77.8% and a specificity of 83.3%.Conclusion Blood glucose concentration and blood glucose variability are important factors to 28-day survival rate in adults with complicated intra -abdominal infection after surgical operation .GLUmax during 24 hours admission to ICU is a good index to predict prognosis for adults with complicated intra -abdominal infection after surgical operation, and the cut-off value of GLUmax is 15.4 mmol/L.