Trends in sepsis incidence and outcomes among people with or without type 2 diabetes mellitus in Spain (2008-2012).
OBJECTIVE
There is conflicting evidence on how type 2 diabetes mellitus (T2DM) influences in-hospital mortality (IHM) in sepsis. We aimed to compare trends in outcomes for sepsis in people with or without T2DM in Spain between 2008 and 2012.


METHODS
We identified all cases with any sepsis diagnosis using national hospital discharge data. We evaluated annual incidence rates for sepsis stratified by T2DM status. We calculated IHM and analyzed trends over time. In a multivariate analysis including potential confounding factors, we tested T2DM as an independent factor for IHM.


RESULTS
Overall, 217,280 cases of any-stage sepsis were diagnosed, of whom 50,611 (23.3%) had T2DM. The annual incidence of sepsis increased during the 5-year period (from 76.5 to 113.3cases/10(5) population). The incidence increase was higher for the population with T2DM (from 16.8 to 27.1 cases/10(5) population; 61.3% relative increment). People with T2DM were significantly older (75.8 ± 11.2 years vs. 71.0 ± 16.4 years) and suffered from more coexisting medical conditions. In the univariate analysis, mortality was higher for the population with T2DM only when septic shock was present (53.3% vs. 51.9%; P=0.002). IHM decreased over time both in participants with (from 45.7% to 38.1%) and without T2DM (from 46.1% to 39.5%). After accounting for all other potential confounders, T2DM was significantly associated with a lower IHM (odds ratio=0.88; 95% confidence interval, 0.86-0.90).


CONCLUSIONS
In Spain, the annual increase in sepsis incidence was higher in people with T2DM, but the risk of dying with sepsis during admission was moderately lower in people with T2DM.
Internal Medicine Department, Hospital General Universitario "Gregorio Marañón", 46, Doctor Esquerdo, 28007 Madrid, Spain. Electronic address: josemaria.demiguel@salud.madrid.org.
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JM
de Miguel-Yanes
Internal Medicine Department, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain. Electronic address: manuel.mendez@salud.madrid.org.
M
M
Méndez-Bailón
Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n, 28292 Alcorcón, Madrid, Spain. Electronic address: rodrigo.jimenez@urjc.es.
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R
Jiménez-García
Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n, 28292 Alcorcón, Madrid, Spain. Electronic address: valentin.hernandez@urjc.es.
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V
Hernández-Barrera
Spanish Agency of Alimentary Safety and Nutrition, Ministry of Health, Social Policy and Equality, 56, Alcalá, 28071 Madrid, Spain. Electronic address: pereznapo@gmail.com.
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N
Pérez-Farinós
Preventive Medicine and Public Health Department, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n, 28292 Alcorcón, Madrid, Spain. Electronic address: ana.lopez@urjc.es.
A
A
López-de-Andrés
D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D013030:Spain / Q000453:epidemiology
In-hospital mortality; Incidence; Sepsis; Septic shock; Type 2 diabetes mellitus