Hubungan Variabilitas Glukosa 72 Jam Pertama Perawatan ICU dengan Mortalitas ICU pada Pasien Kritis

Elizabeth Yasmine, Arif Mansjoer, Dyah Purnamasari, Hamzah Shatri

Abstract

Pendahuluan. Hiperglikemia saat perawatan merupakan faktor risiko yang dapat ditatalaksana dengan optimal untuk menurunkan mortalitas. Penelitian hubungan variabilitas glukosa terhadap mortalitas telah diteliti, namun menggunakan indikator yang bervariasi. Penelitian ini dilakukan untuk mengkaji hubungan variabilitas glukosa yaitu rerata perubahan glukosa absolut (mean absolute glucose change, MAG) dan simpang baku glukosa terhadap mortalitas pasien kritis.
Metode. Studi kohort retrospektif dilakukan pada 280 pasien yang dirawat di intensive care unit (ICU) dan high care unit (HCU) Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta periode Januari 2012-Agustus 2013. Variabel MAG dan simpang baku glukosa dibagi menjadi 4 kuartil. Analisis hubungan antara MAG dan simpang baku glukosa dengan mortalitas dilakukan dengan uji chi Square. Untuk mengeluarkan faktor perancu (skor MSOFA, indeks komorbiditas Charlson, hipoglikemia, dan hiperglikemia) dilakukan uji regresi logistik.
Hasil. Nilai median MAG dan simpang baku gukosa masing-masing adalah 3,3 mg/dL/jam dan 38,3 mg/dL. Proporsi mortalitas yang lebih tinggi didapatkan pada kuartil atas MAG dan simpang baku glukosa dibandingkan kuartil bawah. Berdasarkan uji chi square, didapatkan hasil OR MAG kuartil atas terhadap mortalitas OR 4,26 (IK 95% 1,98-9,15) dan OR simpang baku glukosa kuartil atas terhadap mortalitas OR 2,78 (IK 95% 1,35-5,71). Setelah dilakukan uji regresi logistik didapatkan fully adjusted OR 3,34 (IK 95% 1,08-10,31) untuk MAG dan 0,90 (IK 95% 0,28-2,88) untuk simpang baku glukosa.
Simpulan. Proporsi mortalitas MAG kuartil atas (>8,1 mg/dL/jam) lebih tinggi daripada kuartil bawah (<1,3 mg/dL/jam). Proporsi mortalitas simpang baku glukosa kuartil atas (>59 mg/dL) lebih tinggi daripada kuartil bawah (<22,7 mg/dL). Namun demikian, hasil tersebut tidak bermakna secara statistik.


Kata kunci: mortalitas, rerata perubahan glukosa absolut, simpang baku glukosa, variabilitas glukosa

 

Association of Glucose Variability in the First 72 Hours of ICU Care with ICU Mortality in Critically-III Patients

Introduction. Hyperglycemia during hospitalization is a risk factor that can be managed in order to reduce mortality. Inspite of hyperglycemia, glucose variability also brings negative outcome to cells. Studies about glucose variability effect to mortality had been studied using many variables of glucose variability.

Methods. Retrospective cohort study is done to 280 critical ill patient in ICU and HCU in Cipto Mangunkusumo Hospital who admitted to critical care between January 2012-August 2013. MAG change and glucose standard deviation are divided into 4 quartiles. Relationship between MAG change and glucose standard deviation are analyzed using Chi Square test. To control the confounders (MSOFA score, Charlson comorbidities index, hypoglycemia, and hyperglycemia), logistic regression is done.

Results. Median of MAG change is 3.3 mg/dL/hour and median of glucose standard deviation is 37.63 mg/dL. Mortality proportion is higher in upper quartile of MAG change and glucose standard deviation compared to lower quartile. OR of upper quartile MAG change to ICU mortality is OR 4.26 (95% CI 1.98-9.15) and OR of upper quartile glucose standard deviation to ICU mortality is OR 2.78 (95% CI 1.35-5.71). These results are adjusted to MSOFA score, hypoglycemia, and hyperglycemia. In logistic regression test, fully adjusted OR are 3.34 (95% CI 1.08-10.31) and 0.90 (95% CI 0.28-2.88) for MAG change and glucose standard deviation, respectively.

Conclusions. Mortality proportion of upper quartile of MAG change (>8.1 mg/dL/hour) is higher than lower quartile (<1.3 mg/dL). Mortality proportion of upper quartile glucose standard deviation (>59 mg/dL) is higher than lower quartile(<22.7 mg/dL), but the difference is not statistically significant.

Keywords

glucose standard deviation, glucose variability, mean absolute glucose change, mortality

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