Diabetes does not alter mortality or hemostatic and inflammatory responses in patients with severe sepsis.
OBJECTIVE
Diabetes patients have an increased risk of sepsis. Several inflammatory and coagulant pathways that are activated during sepsis are also up-regulated in diabetes patients. We tested our a priori hypothesis that the presence of diabetes adversely affects the outcome of sepsis.


METHODS
Retrospective analysis of a previously published study.


METHODS
Intensive care units of 164 centers in 11 countries.


METHODS
Eight hundred thirty severe sepsis patients who were admitted to the intensive care unit and who received standard critical care treatment.


METHODS
Patients were stratified into diabetic and nondiabetic patient groups. Mortality was assessed after 28 and 90 days, causative microorganisms were evaluated, and markers of coagulation, fibrinolysis, and inflammation were measured at several time points.


RESULTS
Diabetes was present in 22.7% of all sepsis patients. Throughout the study, plasma glucose levels were higher in diabetic patients. Mortality was equal in diabetic and nondiabetic patients (31.4% vs. 30.5% after 28 days). Markers of coagulation, fibrinolysis, and inflammation were generally equal in diabetic and nondiabetic patients, although on admission diabetic patients had slightly higher levels of anticoagulation markers. Interestingly, nondiabetic patients with admission hyperglycemia (>11.1 mmol/L; 200 mg/dL) had a higher mortality rate compared to those without admission hyperglycemia (43.0% vs. 27.2%).


CONCLUSIONS
Although diabetes is a risk factor for sepsis, once established, the outcome of severe sepsis does not appear to be significantly influenced by the presence of diabetes. In nondiabetic patients, however, admission hyperglycemia is associated with an increased mortality.
Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, The Netherlands. m.e.stegenga@amc.uva.nl
Michiel E
ME
Stegenga
Jean-Louis
JL
Vincent
George M
GM
Vail
Jin
J
Xie
Douglas J
DJ
Haney
Mark D
MD
Williams
Gordon R
GR
Bernard
Tom
T
van der Poll
D001777:Blood Coagulation; D001786:Blood Glucose / Q000032:analysis; D003422:Critical Care; D048909:Diabetes Complications / Q000097:blood* / Q000276:immunology; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000401:mortality; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D001786:Blood Glucose; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha