Shigeki Kushimoto1, Toshikazu Abe2,3, Hiroshi Ogura4, Atsushi Shiraishi5, Daizoh Saitoh6, Seitaro Fujishima7, Toshihiko Mayumi8, Toru Hifumi9, Yasukazu Shiino10, Taka-Aki Nakada11, Takehiko Tarui12, Yasuhiro Otomo13, Kohji Okamoto14, Yutaka Umemura4, Joji Kotani15, Yuichiro Sakamoto16, Junichi Sasaki17, Shin-Ichiro Shiraishi18, Kiyotsugu Takuma19, Ryosuke Tsuruta20, Akiyoshi Hagiwara21, Kazuma Yamakawa22, Tomohiko Masuno23, Naoshi Takeyama24, Norio Yamashita25, Hiroto Ikeda26, Masashi Ueyama27, Satoshi Fujimi22, Satoshi Gando28,29. 1. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. 2. Department of General Medicine, Juntendo University, Bunkyo, Japan. 3. Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan. 4. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 5. Emergency and Trauma Center, Kameda Medical Center, Kamogawa, Japan. 6. Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan. 7. Center for General Medicine Education, Keio University School of Medicine, Shinjuku, Japan. 8. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. 9. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Chuo, Japan. 10. Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan. 11. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chuo-ku, Japan. 12. Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Japan. 13. Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Bunkyō, Japan. 14. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan. 15. Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. 16. Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan. 17. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Japan. 18. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan. 19. Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan. 20. Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube, Japan. 21. Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Japan. 22. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan. 23. Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo, Japan. 24. Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan. 25. Advanced Emergency Medical Service Center Kurume University Hospital, Kurume, Japan. 26. Department of Emergency Medicine, Teikyo University School of Medicine, Itabashi, Japan. 27. Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan. 28. Division of Acute and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 29. Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
Abstract
BACKGROUND: Dysglycemia is frequently observed in patients with sepsis. However, the relationship between dysglycemia and outcome is inconsistent. We evaluate the clinical characteristics, glycemic abnormalities, and the relationship between the initial glucose level and mortality in patients with sepsis. METHODS: This is a retrospective sub-analysis of a multicenter, prospective cohort study. Adult patients with severe sepsis (Sepsis-2) were divided into groups based on blood glucose categories (<70 (hypoglycemia), 70-139, 140-179, and ≥180 mg/dL), according to the admission values. In-hospital mortality and the relationship between pre-existing diabetes and septic shock were evaluated. RESULTS: Of 1158 patients, 69, 543, 233, and 313 patients were categorized as glucose levels <70, 70-139, 140-179, ≥180 mg/dL, respectively. Both the Acute Physiological and Chronic Health Evaluation II and Sequential Organ Failure Assessment (SOFA) scores on the day of enrollment were higher in the hypoglycemic patients than in those with 70-179 mg/dL. The hepatic SOFA scores were also higher in hypoglycemic patients. In-hospital mortality rates were higher in hypoglycemic patients than in those with 70-139 mg/dL (26/68, 38.2% vs 43/221, 19.5%). A significant relationship between mortality and hypoglycemia was demonstrated only in patients without known diabetes. Mortality in patients with both hypoglycemia and septic shock was 2.5-times higher than that in patients without hypoglycemia and septic shock. CONCLUSIONS: Hypoglycemia may be related to increased severity and high mortality in patients with severe sepsis. These relationships were evident only in patients without known diabetes. Patients with both hypoglycemia and septic shock had an associated increased mortality rate.
BACKGROUND:Dysglycemia is frequently observed in patients with sepsis. However, the relationship between dysglycemia and outcome is inconsistent. We evaluate the clinical characteristics, glycemic abnormalities, and the relationship between the initial glucose level and mortality in patients with sepsis. METHODS: This is a retrospective sub-analysis of a multicenter, prospective cohort study. Adult patients with severe sepsis (Sepsis-2) were divided into groups based on blood glucose categories (<70 (hypoglycemia), 70-139, 140-179, and ≥180 mg/dL), according to the admission values. In-hospital mortality and the relationship between pre-existing diabetes and septic shock were evaluated. RESULTS: Of 1158 patients, 69, 543, 233, and 313 patients were categorized as glucose levels <70, 70-139, 140-179, ≥180 mg/dL, respectively. Both the Acute Physiological and Chronic Health Evaluation II and Sequential Organ Failure Assessment (SOFA) scores on the day of enrollment were higher in the hypoglycemicpatients than in those with 70-179 mg/dL. The hepatic SOFA scores were also higher in hypoglycemicpatients. In-hospital mortality rates were higher in hypoglycemicpatients than in those with 70-139 mg/dL (26/68, 38.2% vs 43/221, 19.5%). A significant relationship between mortality and hypoglycemia was demonstrated only in patients without known diabetes. Mortality in patients with both hypoglycemia and septic shock was 2.5-times higher than that in patients without hypoglycemia and septic shock. CONCLUSIONS:Hypoglycemia may be related to increased severity and high mortality in patients with severe sepsis. These relationships were evident only in patients without known diabetes. Patients with both hypoglycemia and septic shock had an associated increased mortality rate.
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