Diabetes patients and non-diabetic patients intensive care unit and hospital mortality risks associated with sepsis

Abstract

AIM:To compare mortality risks associated with known diabetic patients to hyperglycemic non-diabetic patients.METHODS: �ub�ed data base was searched �or pa�ub�ed data base was searched �or patients with sepsis, bacteremia, mortality and diabetes. Articles that also identi�ied new onset hyperglycemia (NOH) (�asting blood glucose > 125 mg/dL or random blood glucose > 199 mg/dL) were identi�ied and reviewed. Nine studies were evaluated with regards to hyperglycemia and hospital mortality and �ive o� the nine were summarized with regards to intensive care unit (�C�) mortality.(�C�) mortality. �C�) mortality. ) mortality. mortality. RESULTS:Historically hyperglycemia has been believed to be equally harm�ul in known diabetic patients and non-diabetics patients admitted to the hospital. �nexpectedly, having a history o� diabetes when admitted to the hospital was associated with a reduced risk o� hospital mortality. Approximately 17% o� patients admitted to hospital have NOH and 24% have diabetes mellitus. Hospital mortality was signi�icantly increased in all nine studies o� patients with NOH as compared to known diabetic patients (26.7% ± 3.4% vs 12.5% ± 3.4%, � <� �.�5�� analysis o� variance). �nad�usted �C� �.�5�� analysis o� variance). �nad�usted �C� �.�5�� analysis o� variance). �nad�usted �C� mortality was evaluated in �ive studies and was more than doubled �or those patients with NOH as compared to known diabetic patients (25.3% ± 3.3% vs 12.8% ± 2.6%, � <� �.�5) despite having similar blood glucose �.�5) despite having similar blood glucose �.�5) despite having similar blood glucose concentrations. �ost importantly, having NOH was associated with an increased �C� and a 2.7-�old increase in hospital mortality when compared to hyperglycemic diabetic patients. The mortality benefit of being diabetic is unclear but may have to do with adaptation to hyperglycemia over time. Having a history o� diabetes mellitus and prior episodes o� hyperglycemia may provide time �or the immune system to adapt to hyperglycemia and result in a reduced mortality risk. �nderstanding why diabetic patients have a lower than expected hospital mortality rate even with bacteremia or acute respiratory distress syndrome needs �urther study. CONCLUSION:Having hyperglycemia without a history o� previous diabetes mellitus is a ma�or independent risk �actor �or �C� and hospital mortality.

Diagnosis trajectories of prior multi-morbidity predict sepsis mortality

“…RR sepsis dead for patients with diabetes has been debated recently in the literature with studies indicating both higher and lower mortality risk12131415. In our study ‘insulin dependent diabetes mellitus’ (IDDM) increased the risk (RR sepsis dead  = 1.13, p = 1.77·10 −30 ), whereas NIDDM had no effect (RR sepsis dead  = 1.11, p = 0.15).…”

“…Specifically, it has been discussed whether diabetes increases or decreases the risk of dying from sepsis12131415. In most papers, the authors do not distinguish between IDDM and NIDDM, which was possible for us due to the size of the data set.…”

Sepsis‐induced activation of endogenous GLP‐1 system is enhanced in type 2 diabetes

“…Hyperglycaemia during sepsis is associated with more severe disease and poorer prognosis . However, mortality in hyperglycaemic critically ill patients has been reported to be significantly higher in patients without a history of diabetes mellitus compared to patients with known diabetes . It remains unknown whether the association of new onset hyperglycaemia and mortality during sepsis is entirely due to the toxic effect of hyperglycaemia or the hyperglycaemia is simply a marker of stress and severity of disease .…”

“…It remains unknown whether the association of new onset hyperglycaemia and mortality during sepsis is entirely due to the toxic effect of hyperglycaemia or the hyperglycaemia is simply a marker of stress and severity of disease . It was also suggested that prior episodes of hyperglycaemia in patients with diabetes may provide time for immune system to adapt to hyperglycaemia and result in a reduced mortality risk in sepsis of diabetic subjects . However, the mechanism(s) linking previous exposure to glucose to enhanced immune adaptation to sepsis in T2D are unknown.…”

Association of Hyperglycemia with In-Hospital Mortality in Septicemia

“…17 The reason of less pronounced adverse effect of hyperglycemia in diabetics is not very clear, though it is proposed that diabetics have lesser immune mediated organ dysfunction and lung injury that prevents deleterious outcomes in diabetics as compared to non-diabetics. 18 We additionally report that in our Pakistani population, association of hyperglycemia with in-hospital mortality is statistically significant in non-diabetic female population while it is insignificant in male population.…”