Shigeki Kushimoto1, Satoshi Gando2, Daizoh Saitoh3, Toshihiko Mayumi4, Hiroshi Ogura5, Seitaro Fujishima6, Tsunetoshi Araki7, Hiroto Ikeda8, Joji Kotani9, Yasuo Miki10, Shin-Ichiro Shiraishi11, Koichiro Suzuki12, Yasushi Suzuki13, Naoshi Takeyama14, Kiyotsugu Takuma15, Ryosuke Tsuruta16, Yoshihiro Yamaguchi17, Norio Yamashita18, Naoki Aikawa6. 1. Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan. 2. Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine Hokkaido University Graduate School of Medicine Sapporo-shi Japan. 3. Division of Traumatology Research Institute, National Defense Medical College Tokorozawa-shi Japan. 4. Department of Emergency and Critical Care Medicine University of Occupational and Environmental Health Kitakyushu Japan. 5. Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita-shi Japan. 6. Department of Emergency and Critical Care Medicine School of Medicine, Keio University Tokyo Japan. 7. Department of Emergency and Critical Care Medicine, Trauma Center St. Mary's Hospital Kurume-shi Japan. 8. Department of Emergency Medicine, Trauma and Resuscitation Center Teikyo University School of Medicine Tokyo Japan. 9. Department of Emergency, Critical Care and Disaster Medicine Hyogo College of Medicine Nishinomiya-shi Japan. 10. Advanced Critical Care Center Aichi Medical University Hospital Aichi Japan. 11. Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan. 12. Department of Acute Medicine Kawasaki Medical School Kurashiki-shi Japan. 13. Department of Critical Care Medicine Iwate Medical University Morioka-shi Japan. 14. Department of Emergency and Acute Intensive Care Medicine Fujita Health University Toyoake-shi Japan. 15. Emergency and Critical Care Center Kawasaki Municipal Hospital Kawasaki-shi Japan. 16. Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube-shi Japan. 17. Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan. 18. Department of Emergency and Critical Care Medicine School of Medicine, Kurume University Kurume-shi Japan.
Abstract
Aim: To determine whether glycemic abnormality and pre-existing diabetes are associated with disease severity and mortality in patients with severe sepsis. Methods: Six hundred and nineteen patients with severe sepsis were grouped into four categories according to their blood glucose levels (<100, 100-199, 200-299, and ≥300 mg/dL). We compared disease severity and mortality between glycemic categories. In addition, we examined whether there was any relationship with pre-existing diabetes status. Results: There were no significant differences in disseminated intravascular coagulation, Sequential Organ Failure Assessment, or Acute Physiology and Chronic Health Evaluation II scores and mortality rates between patients with or without pre-existing diabetes. However, in patients without pre-existing diabetes, those with blood glucose level <100 mg/dL had higher disseminated intravascular coagulation, Sequential Organ Failure Assessment, and Acute Physiology and Chronic Health Evaluation II scores than those with levels of 100-299 mg/dL. In addition, those with level ≥300 mg/dL had a higher hospital mortality rate than those with levels of 100-199 mg/dL (odds ratio = 4.837). Multivariate logistic regression analysis revealed that a blood glucose level ≥300 mg/dL is an independent predictor of hospital mortality in these patients. In contrast, no significant differences among severity scores or mortality were observed in patients with pre-existing diabetes. Conclusions: In patients with severe sepsis, the impact of glycemic abnormality on disease severity and hospital mortality depends on the pre-existing diabetes status. Specifically, a blood glucose level ≥300 mg/dL may be associated with increased mortality in patients without pre-existing diabetes.
Aim: To determine whether glycemic abnormality and pre-existing diabetes are associated with disease severity and mortality in patients with severe sepsis. Methods: Six hundred and nineteen patients with severe sepsis were grouped into four categories according to their blood glucose levels (<100, 100-199, 200-299, and ≥300 mg/dL). We compared disease severity and mortality between glycemic categories. In addition, we examined whether there was any relationship with pre-existing diabetes status. Results: There were no significant differences in disseminated intravascular coagulation, Sequential Organ Failure Assessment, or Acute Physiology and Chronic Health Evaluation II scores and mortality rates between patients with or without pre-existing diabetes. However, in patients without pre-existing diabetes, those with blood glucose level <100 mg/dL had higher disseminated intravascular coagulation, Sequential Organ Failure Assessment, and Acute Physiology and Chronic Health Evaluation II scores than those with levels of 100-299 mg/dL. In addition, those with level ≥300 mg/dL had a higher hospital mortality rate than those with levels of 100-199 mg/dL (odds ratio = 4.837). Multivariate logistic regression analysis revealed that a blood glucose level ≥300 mg/dL is an independent predictor of hospital mortality in these patients. In contrast, no significant differences among severity scores or mortality were observed in patients with pre-existing diabetes. Conclusions: In patients with severe sepsis, the impact of glycemic abnormality on disease severity and hospital mortality depends on the pre-existing diabetes status. Specifically, a blood glucose level ≥300 mg/dL may be associated with increased mortality in patients without pre-existing diabetes.
Entities:
Keywords:
Critical care; diabetes mellitus; hyperglycemia; severe sepsis
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