title: Acute Kidney Injury in Severe Sepsis and Septic Shock in Patients with and without Diabetes Mellitus: A Multicenter Study.
abstract: BACKGROUND
  Whether diabetes mellitus increases the risk of acute kidney injury (AKI) during sepsis is controversial.
  
  
  METHODS
  We used a case-control design to compare the frequency of AKI, use of renal replacement therapy (RRT), and renal recovery in patients who had severe sepsis or septic shock with or without diabetes. The data were from the Outcomerea prospective multicenter database, in which 12 French ICUs enrolled patients admitted between January 1997 and June 2009.
  
  
  RESULTS
  First, we compared 451 patients with severe sepsis or septic shock and diabetes to 3,277 controls with severe sepsis or septic shock and without diabetes. Then, we compared 318 cases (with diabetes) to 746 matched controls (without diabetes). Diabetic patients did not have a higher frequency of AKI (hazard ratio [HR], 1.18; P = 0.05]) or RRT (HR, 1.09; P = 0.6). However, at discharge, diabetic patients with severe sepsis or septic shock who experienced acute kidney injury during the ICU stay and were discharged alive more often required RRT (9.5% vs. 4.8%; P = 0.02), had higher serum creatinine values (134 vs. 103 µmoL/L; P<0.001) and had less often recovered a creatinine level less than 1.25 fold the basal creatinine (41.1% vs. 60.5%; P<0.001).
  
  
  CONCLUSIONS
  In patients with severe sepsis or septic shock, diabetes is not associated with occurrence of AKI or need for RRT but is an independent risk factor for persistent renal dysfunction in patients who experience AKI during their ICU stay.
authors.affiliation: Service de Réanimation Médicale, AP-HP, Hôpital Saint-Louis, Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Venot
authors.affiliation: Service de Médecine Vasculaire et Hypertension artérielle, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Lise
authors.initials: L
authors.lastname: Weis
authors.affiliation: Service de Réanimation, AP-HP, Hôpital Avicenne, Paris, France; Faculté de Médecine, Université Paris 13, Bobigny, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Clec'h
authors.affiliation: Service de Réanimation Médicale, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France; Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire Edouard Herriot, Lyon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Allaouchiche
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier de Gonesse, Gonesse, France.
authors.forename: Dany
authors.initials: D
authors.lastname: Goldgran-Tolédano
authors.affiliation: Service de Réanimation Polyvalente, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.affiliation: Service de Physiologie, AP-HP, Hôpital Cochin, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier Universitaire de Grenoble, Grenoble, France; U 823, Université de Grenoble 1, Grenoble, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.affiliation: Service de Réanimation Médicale, AP-HP, Hôpital Saint-Louis, Paris, France; Faculté de Médecine, Université Paris 5, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012772:Shock, Septic / Q000097:blood / Q000453:epidemiology
chemical_list: D003404:Creatinine