Diabetic patients have a decreased incidence of acute respiratory distress syndrome.
OBJECTIVE
Our ability to predict which critically ill patients will develop acute respiratory distress syndrome (ARDS) is imprecise. Based on the effects of diabetes mellitus on the inflammatory cascade, we hypothesized that a history of diabetes might alter the incidence of ARDS.


METHODS
A prospective multicenter study.


METHODS
Intensive care units at four university medical centers.


METHODS
One hundred thirteen consecutive patients with septic shock.


METHODS
None.


RESULTS
All patients were prospectively followed during their intensive care course for the development of ARDS. A history of diabetes was identified in 28% (32/113) of the patients. In this study, nondiabetics were more likely to develop septic shock from a pulmonary source (48%, 39/81) compared with diabetics (25%, 8/32) (p = .02). Forty-one percent (46/113) of the patients with septic shock developed ARDS. Forty-seven percent of the nondiabetic patients developed ARDS compared with only 25% of those with diabetes (p = .03, relative risk = 0.53, 95% confidence interval = 0.28-0.98). In a multivariate logistic regression analysis, when we adjusted for several variables including source of infection, the effect of diabetes on the incidence of ARDS remained significant (p = .03, odds ratio = 0.33, 95% confidence interval = 0.12-0.90).


CONCLUSIONS
In patients with septic shock, a history of diabetes is associated with a lower risk of developing ARDS compared with nondiabetics.
Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
M
M
Moss
D M
DM
Guidot
K P
KP
Steinberg
G F
GF
Duhon
P
P
Treece
R
R
Wolken
L D
LD
Hudson
P E
PE
Parsons
D018806:APACHE; D001786:Blood Glucose; D003422:Critical Care; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D012772:Shock, Septic / Q000145:classification / Q000150:complications*
D001786:Blood Glucose