title: Severe sepsis and diabetes mellitus have additive effects on red blood cell deformability.
abstract: OBJECTIVE
  Diabetes mellitus is accompanied by microvascular complications leading to organ dysfunction, while sepsis is a major cause of morbidity and mortality in diabetics. We addressed the hypothesis that red blood cell (RBC) deformability may be additively compromised in septic diabetic patients, leading to a further impairment of microcirculation.
  
  
  METHODS
  Forty patients suffering from severe sepsis, 12 patients suffering from diabetes and 24 diabetic patients with severe sepsis were enrolled. A filtration method and a hemorheometer were used to measure the RBCs' index of rigidity (IR).
  
  
  RESULTS
  We observed no differences in severity, organ dysfunction and outcome between diabetic and non-diabetic septic patients. Mean SAPS II score was 23.5% vs 26.8% in non-diabetic and diabetic septic patients, respectively. The mortality in non-diabetic septic patients was 22.5% and in septic diabetics was 34.3%, while septic shock occurred in 15.0% and 20.8%, respectively. We detected higher IR (17.72+/-6.31) in septic diabetics than in patients with diabetes and no sepsis (12.26+/-2.28, p< or =0.001) and in patients with sepsis and no diabetes (13.9+/-2.86, p< or =0.01).
  
  
  CONCLUSIONS
  The presence of diabetes mellitus seems to affect the already compromised RBC deformability of septic patients, probably leading to serious microcirculatory functional impairments in septic diabetic patients.
authors.affiliation: Department of Mechanical Engineering and Aeronautics, University of Patras, Rion-Patras, 26500 Patras, Greece.
authors.forename: A G
authors.initials: AG
authors.lastname: Moutzouri
authors.forename: G A
authors.initials: GA
authors.lastname: Athanassiou
authors.forename: D
authors.initials: D
authors.lastname: Dimitropoulou
authors.forename: A T
authors.initials: AT
authors.lastname: Skoutelis
authors.forename: C A
authors.initials: CA
authors.lastname: Gogos
mesh_terms: D003920:Diabetes Mellitus / Q000473:pathology*; D003928:Diabetic Nephropathies / Q000097:blood* / Q000209:etiology; D004907:Erythrocyte Deformability; D004912:Erythrocytes / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D012772:Shock, Septic / Q000150:complications