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Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis

OBJECTIVES: Poor glycemic control is associated with mortality in critical patients with diabetes. The aim of the study was to assess the predicting value of stress hyperglycemia in patients with diabetes following hospital admission for sepsis. DESIGN: Retrospective observational study. SETTING: Ad...

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Autores principales: Fabbri, Andrea, Marchesini, Giulio, Benazzi, Barbara, Morelli, Alice, Montesi, Danilo, Bini, Cesare, Rizzo, Stefano Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365708/
https://www.ncbi.nlm.nih.gov/pubmed/32766552
http://dx.doi.org/10.1097/CCE.0000000000000152
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author Fabbri, Andrea
Marchesini, Giulio
Benazzi, Barbara
Morelli, Alice
Montesi, Danilo
Bini, Cesare
Rizzo, Stefano Giovanni
author_facet Fabbri, Andrea
Marchesini, Giulio
Benazzi, Barbara
Morelli, Alice
Montesi, Danilo
Bini, Cesare
Rizzo, Stefano Giovanni
author_sort Fabbri, Andrea
collection PubMed
description OBJECTIVES: Poor glycemic control is associated with mortality in critical patients with diabetes. The aim of the study was to assess the predicting value of stress hyperglycemia in patients with diabetes following hospital admission for sepsis. DESIGN: Retrospective observational study. SETTING: Adult, emergency department, and critical care in a district hospital. PATIENTS: In a 10-year retrospective analysis of sepsis-related hospitalizations in the emergency department, we carried out a secondary analysis of 915 patients with diabetes (males, 54.0%) in whom both fasting glucose at entry and glycosylated hemoglobin were available. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients’ mean age was 79.0 (sd 11.0), glucose at admission was 174.0 mg/dL (74.3 mg/dL), and glycosylated hemoglobin was 7.7% (1.7%). Stress hyperglycemia was defined by the stress hyperglycemia ratio, that is, fasting glucose concentration at admission divided by the estimated average glucose derived from glycosylated hemoglobin. A total of 305 patients died (33.3%) in hospital. Factors associated with in-hospital case fatality rate were tested by multivariable logistic model. Ten variables predicting outcomes in the general population were confirmed in the presence of diabetes (male sex, older age, number of organ dysfunction diagnoses, in particular cardiovascular dysfunction, infection/parasitic, circulatory, respiratory, digestive diseases diagnosis, and Charlson Comorbidity Index). In addition, also glycemic control (glycosylated hemoglobin: odds ratio, 1.17; 95% CI, 1.15–1.40) and stress hyperglycemia (stress hyperglycemia ratio: 5.25; 3.62–7.63) were significant case fatality rate predictors. High stress hyperglycemia ratio (≥ 1.14) significantly increased the discriminant capacity (area under the receiver operating characteristic curve, 0.864; se, 0.013; p < 0.001). CONCLUSIONS: Stress hyperglycemia, even in the presence of diabetes, is predictive of mortality following admission for sepsis. Stress hyperglycemia ratio may be used to refine prediction of an unfavorable outcome.
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spelling pubmed-73657082020-08-05 Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis Fabbri, Andrea Marchesini, Giulio Benazzi, Barbara Morelli, Alice Montesi, Danilo Bini, Cesare Rizzo, Stefano Giovanni Crit Care Explor Observational Study OBJECTIVES: Poor glycemic control is associated with mortality in critical patients with diabetes. The aim of the study was to assess the predicting value of stress hyperglycemia in patients with diabetes following hospital admission for sepsis. DESIGN: Retrospective observational study. SETTING: Adult, emergency department, and critical care in a district hospital. PATIENTS: In a 10-year retrospective analysis of sepsis-related hospitalizations in the emergency department, we carried out a secondary analysis of 915 patients with diabetes (males, 54.0%) in whom both fasting glucose at entry and glycosylated hemoglobin were available. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients’ mean age was 79.0 (sd 11.0), glucose at admission was 174.0 mg/dL (74.3 mg/dL), and glycosylated hemoglobin was 7.7% (1.7%). Stress hyperglycemia was defined by the stress hyperglycemia ratio, that is, fasting glucose concentration at admission divided by the estimated average glucose derived from glycosylated hemoglobin. A total of 305 patients died (33.3%) in hospital. Factors associated with in-hospital case fatality rate were tested by multivariable logistic model. Ten variables predicting outcomes in the general population were confirmed in the presence of diabetes (male sex, older age, number of organ dysfunction diagnoses, in particular cardiovascular dysfunction, infection/parasitic, circulatory, respiratory, digestive diseases diagnosis, and Charlson Comorbidity Index). In addition, also glycemic control (glycosylated hemoglobin: odds ratio, 1.17; 95% CI, 1.15–1.40) and stress hyperglycemia (stress hyperglycemia ratio: 5.25; 3.62–7.63) were significant case fatality rate predictors. High stress hyperglycemia ratio (≥ 1.14) significantly increased the discriminant capacity (area under the receiver operating characteristic curve, 0.864; se, 0.013; p < 0.001). CONCLUSIONS: Stress hyperglycemia, even in the presence of diabetes, is predictive of mortality following admission for sepsis. Stress hyperglycemia ratio may be used to refine prediction of an unfavorable outcome. Wolters Kluwer Health 2020-07-15 /pmc/articles/PMC7365708/ /pubmed/32766552 http://dx.doi.org/10.1097/CCE.0000000000000152 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Observational Study
Fabbri, Andrea
Marchesini, Giulio
Benazzi, Barbara
Morelli, Alice
Montesi, Danilo
Bini, Cesare
Rizzo, Stefano Giovanni
Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis
title Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis
title_full Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis
title_fullStr Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis
title_full_unstemmed Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis
title_short Stress Hyperglycemia and Mortality in Subjects With Diabetes and Sepsis
title_sort stress hyperglycemia and mortality in subjects with diabetes and sepsis
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365708/
https://www.ncbi.nlm.nih.gov/pubmed/32766552
http://dx.doi.org/10.1097/CCE.0000000000000152
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