Prognostic value of low blood glucose at the presentation of E. coli bacteremia.
OBJECTIVE
Septicemia is the tenth leading cause of death in the United States, and Escherichia coli is the most common isolate in blood cultures. Low blood glucose is a known complication of sepsis. The prognostic role of low blood glucose in E. coli bacteremia is unknown. The study's objective was to identify the incidence of low blood glucose at the presentation of E. coli bacteremia and determine its influence on prognosis and outcome.


METHODS
A retrospective cohort study was conducted in university-affiliated community hospitals. Subjects were consecutive patients diagnosed with E. coli bacteremia between 1997 and 2003. We identified 1060 patients with documented E. coli bacteremia. We excluded 105 patients who were younger than 18 years old or pregnant. We recorded demographic characteristics, discharge diagnosis, and outcome.


RESULTS
Among the 955 patients with E. coli bacteremia, the average age was 64+/-19.4 years. Overall, 4.6% had documented low blood glucose (blood glucose <70 mg/dL) at presentation. The incidence of low blood glucose was the same in diabetic and nondiabetic patients. Patients with low blood glucose had a 4.7 times higher risk of death compared to patients with non-low blood glucose. Race, age, sex, and diabetes had no influence on survival. Gastrointestinal and genitourinary sources for E. coli bacteremia were more commonly associated with low blood glucose (P <.001). The study was limited to E. coli-positive blood cultures and to the one hospital system.


CONCLUSIONS
Low blood glucose is present at the onset of E. coli bacteremia in 4.6% of patients. This represents a potentially large number of patients because E. coli is the most common blood culture isolate. Low blood glucose predicts poor outcome, especially in patients with abnormal hepatic and renal function. Low blood glucose should be considered an early clinical sign of E. coli bacteremia and aggressive therapy should be instituted to potentially save lives.
Alamgir
Shamsuddin
S
Department of Medicine, UCSF Fresno Medical Education Program, Fresno, Calif 93702, USA.
Volkova
Natalia B
NB
Peterson
Michael W
MW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016470:Bacteremia / Q000097:blood / Q000382:microbiology* / Q000401:mortality*; D001786:Blood Glucose / Q000378:metabolism*; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004927:Escherichia coli Infections / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis
D001786:Blood Glucose