The association of diabetes and hyperglycemia with sepsis outcomes: a population-based cohort analysis
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IM - ORIGINAL
The association of diabetes and hyperglycemia with sepsis outcomes: a population‑based cohort analysis Yarden Zohar1 · Shani Zilberman Itskovich2 · Shlomit Koren3,5 · Ronit Zaidenstein1,5 · Dror Marchaim4,5 · Ronit Koren1,5 Received: 8 February 2020 / Accepted: 12 September 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract The independent association of diabetes and hyperglycemia on the outcomes of sepsis remains unclear. We conducted retrospective cohort analyses of outcomes among patients with community-onset sepsis admitted to Shamir Medical Center, Israel (08-12/2016). Statistical associations were queried by Cox and logistic regressions, controlled for by matched propensity score analyses. Among 1527 patients with community-onset sepsis, 469 (30.7%) were diabetic. Diabetic patients were significantly older, with advanced complexity of comorbidities, and were more often exposed to healthcare environments. Despite statistically significant univariable associations with in-hospital and 90-day mortality, the adjusted Hazard Ratios (aHR) were 1.21 95% CI 0.8–1.71, p = 0.29 and 1.13 95% CI 0.86–1.49, p = 0.37, respectively. However, hyperglycemia at admission (i.e., above 200 mg/dl (was independently associated with: increased in-hospital mortality, aHR 1.48 95% CI 1.02–2.16, p = 0.037, 30-day mortality, aHR 1.8 95% CI 1.12–2.58, p = 0.001), and 90-day mortality, aHR 1.68 95% CI 1.24–2.27, p = 0.001. This association was more robust among diabetic patients than those without diabetes. In this study, diabetes was not associated with worse clinical outcomes in community-onset sepsis. However, high glucose levels at sepsis onset are independently associated with a worse prognosis, particularly among diabetic patients. Future trials should explore whether glycemic control could impact the outcomes and should be part of the management of sepsis, among the general adult septic population. Keywords Diabetes · Hyperglycemia · Sepsis · Community-acquired infections · Multi-drug resistant · MDR
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-020-02507-9) contains supplementary material, which is available to authorized users. * Ronit Koren [email protected] 1
Department of Internal Medicine A, Shamir (Assaf Harofeh) Medical Center, 7030000 Zerifin, Israel
2
Department of Nephrology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
3
Diabetes Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
4
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
5
Sackler Faculty of Medicine, Tel-Aviv University, Tel‑Aviv, Israel
Increasing prevalence of obesity and aging of the population have culminated into an exponential rise in the worldwide rates of diabetes mellitus (DM), imposing a significant burden on individuals and on public health [1]. Sepsis incidence is increasing as a cause of morbidity and mortality in the population [2]. People of advanced age and patients
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