Acurácia de diferentes métodos para mensuração de glicemia em pacientes graves
Palavras-chave:
Hiperglicemia, Hipoglicemia, Sepse, Norepinefrina, Choque sépticoResumo
CONTEXTO E OBJETIVO: Apesar de glicosímetros não serem validados para unidades de terapia intensiva (UTI), seu uso é corriqueiro. O objetivo foi avaliar a acurácia e concordância clínica entre a glicemia arterial por colorimetria (glicA-lab), glicemias capilar (glicC-fita) e arterial (glicA-fita) por glicosimetria, e venosa central por colorimetria (glicV-lab). TIPO DE ESTUDO E LOCAL: Estudo transversal realizado em hospital universitário. MÉTODO: Foram incluídos 40 pacientes com choque séptico e indivíduos estáveis, sem infecção. A correlação entre medidas foi avaliada tanto na amostra global quanto nos subgrupos em uso de noradrenalina e com sinais de hipoperfusão tecidual. RESULTADOS: A glicC-fita mostrou pior correlação (r = 0,8289) e concordância (-9,87 ± 31,76). Esta superou os limites aceitáveis de variação do Clinical and Laboratory Standards Institute em 23,7% dos casos, sendo maior que a glicA-lab em 90% das vezes. A glicA-fita teve a melhor correlação (r = 0,9406), com concordância de -6,75 ± 19,07 e variação significativa em 7,9%. Para a glicV-lab, obteve-se r = 0,8549, concordância de -4,20 ± 28,37 e variação significativa em 15,7%. Variação significativa foi mais frequente em pacientes com noradrenalina (36,4% versus 6,3%, P = 0,03), mas não nos com hipoperfusão. Houve discordância de conduta clínica em 25%, 22,5% e 15% dos casos para glicC-fita, glicV-lab e glicA-fita, respectivamente. CONCLUSÃO: O uso de glicC-fita deveria ser evitado, principalmente se há uso de noradrenalina. Geralmente, este método superestima a glicemia real e acarreta erros de conduta. REGISTRO DO ENSAIO CLÍNICO: ACTRN12608000513314 (registrado como estudo observacional transversal).
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