Open AccessImpact of serum glucose levels on disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis
Author(s) -
Kushimoto Shigeki,
Gando Satoshi,
Saitoh Daizoh,
Mayumi Toshihiko,
Ogura Hiroshi,
Fujishima Seitaro,
Araki Tsunetoshi,
Ikeda Hiroto,
Kotani Joji,
Miki Yasuo,
Shiraishi Shinichiro,
Suzuki Koichiro,
Suzuki Yasushi,
Takeyama Naoshi,
Takuma Kiyotsugu,
Tsuruta Ryosuke,
Yamaguchi Yoshihiro,
Yamashita Norio,
Aikawa Naoki
Publication year - 2015
Publication title -
acute medicine and surgery
Language(s) - English
Resource type - Journals
ISSN - 2052-8817
DOI - 10.1002/ams2.59
Subject(s) - medicine , sepsis , diabetes mellitus , glycemic , odds ratio , disseminated intravascular coagulation , mortality rate , gastroenterology , prospective cohort study , severity of illness , insulin , endocrinology
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/d L ). 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, S equential O rgan F ailure A ssessment, or A cute P hysiology and C hronic H ealth E valuation 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/d L had higher disseminated intravascular coagulation, S equential O rgan F ailure A ssessment, and A cute P hysiology and C hronic H ealth E valuation II scores than those with levels of 100–299 mg/d L . In addition, those with level ≥300 mg/d L had a higher hospital mortality rate than those with levels of 100–199 mg/d L (odds ratio = 4.837). Multivariate logistic regression analysis revealed that a blood glucose level ≥300 mg/d L 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/d L may be associated with increased mortality in patients without pre‐existing diabetes.