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Impact of blood glucose abnormalities on outcomes and disease severity in patients with severe sepsis: An analysis from a multicenter, prospective survey of severe sepsis.

ABSTRACT: BACKGROUND:Dysglycemia is frequently observed in patients with sepsis. However, the relationship between dysglycemia and outcome is inconsistent. We evaluate the clinical characteristics, glycemic abnormalities, and the relationship between the initial glucose level and mortality in patients with sepsis. METHODS:This is a retrospective sub-analysis of a multicenter, prospective cohort study. Adult patients with severe sepsis (Sepsis-2) were divided into groups based on blood glucose categories (<70 (hypoglycemia), 70-139, 140-179, and ?180 mg/dL), according to the admission values. In-hospital mortality and the relationship between pre-existing diabetes and septic shock were evaluated. RESULTS:Of 1158 patients, 69, 543, 233, and 313 patients were categorized as glucose levels <70, 70-139, 140-179, ?180 mg/dL, respectively. Both the Acute Physiological and Chronic Health Evaluation II and Sequential Organ Failure Assessment (SOFA) scores on the day of enrollment were higher in the hypoglycemic patients than in those with 70-179 mg/dL. The hepatic SOFA scores were also higher in hypoglycemic patients. In-hospital mortality rates were higher in hypoglycemic patients than in those with 70-139 mg/dL (26/68, 38.2% vs 43/221, 19.5%). A significant relationship between mortality and hypoglycemia was demonstrated only in patients without known diabetes. Mortality in patients with both hypoglycemia and septic shock was 2.5-times higher than that in patients without hypoglycemia and septic shock. CONCLUSIONS:Hypoglycemia may be related to increased severity and high mortality in patients with severe sepsis. These relationships were evident only in patients without known diabetes. Patients with both hypoglycemia and septic shock had an associated increased mortality rate.

SUBMITTER: Kushimoto S

PROVIDER: S-EPMC7065801 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Impact of blood glucose abnormalities on outcomes and disease severity in patients with severe sepsis: An analysis from a multicenter, prospective survey of severe sepsis.

Kushimoto Shigeki S Abe Toshikazu T Ogura Hiroshi H Shiraishi Atsushi A Saitoh Daizoh D Fujishima Seitaro S Mayumi Toshihiko T Hifumi Toru T Shiino Yasukazu Y Nakada Taka-Aki TA Tarui Takehiko T Otomo Yasuhiro Y Okamoto Kohji K Umemura Yutaka Y Kotani Joji J Sakamoto Yuichiro Y Sasaki Junichi J Shiraishi Shin-Ichiro SI Takuma Kiyotsugu K Tsuruta Ryosuke R Hagiwara Akiyoshi A Yamakawa Kazuma K Masuno Tomohiko T Takeyama Naoshi N Yamashita Norio N Ikeda Hiroto H Ueyama Masashi M Fujimi Satoshi S Gando Satoshi S

PloS one 20200311 3

<h4>Background</h4>Dysglycemia is frequently observed in patients with sepsis. However, the relationship between dysglycemia and outcome is inconsistent. We evaluate the clinical characteristics, glycemic abnormalities, and the relationship between the initial glucose level and mortality in patients with sepsis.<h4>Methods</h4>This is a retrospective sub-analysis of a multicenter, prospective cohort study. Adult patients with severe sepsis (Sepsis-2) were divided into groups based on blood gluco ...[more]

PMID: 32160234

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Project description:Background:Sepsis is a global threat but insufficiently studied in Southeast Asia. The objective was to evaluate management, outcomes, adherence to sepsis bundles, and mortality prediction of maximum Sequential Organ Failure Assessment (SOFA) scores in patients with community-acquired sepsis in Southeast Asia. Methods:We prospectively recruited hospitalized adults within 24 h of admission with community-acquired infection at nine public hospitals in Indonesia (n?=?3), Thailand (n?=?3), and Vietnam (n?=?3). In patients with organ dysfunction (total SOFA score ??2), we analyzed sepsis management and outcomes and evaluated mortality prediction of the SOFA scores. Organ failure was defined as the maximum SOFA score ??3 for an individual organ system. Results:From December 2013 to December 2015, 454 adult patients presenting with community-acquired sepsis due to diverse etiologies were enrolled. Compliance with sepsis bundles within 24 h of admission was low: broad-spectrum antibiotics in 76% (344/454), ??1500 mL fluid in 50% of patients with hypotension or lactate ??4 mmol/L (115/231), and adrenergic agents in 71% of patients with hypotension (135/191). Three hundred and fifty-five patients (78%) were managed outside of ICUs. Ninety-nine patients (22%) died. Total SOFA score on admission of those who subsequently died was significantly higher than that of those who survived (6.7 vs. 4.6, p?<?0.001). The number of organ failures showed a significant correlation with 28-day mortality, which ranged from 7% in patients without any organ failure to 47% in those with failure of at least four organs (p?<?0.001). The area under the receiver operating characteristic curve of the total SOFA score for discrimination of mortality was 0.68 (95% CI 0.62-0.74). Conclusions:Community-acquired sepsis in Southeast Asia due to a variety of pathogens is usually managed outside the ICU and with poor compliance to sepsis bundles. In this population, calculation of SOFA scores is feasible and SOFA scores are associated with mortality. Trial registration:ClinicalTrials.gov, NCT02157259. Registered 5 June 2014, retrospectively registered.

Project description:BackgroundThe prognostic effect of admission blood glucose (ABG) for patients with acute myocardial infarction (AMI) has not been well validated, especially in patients with diabetes. We performed this study to assess the predictive value of ABG for all-cause mortality in AMI patients with different glucose metabolism status.MethodsWe evaluated a total of 6,892 AMI patients from the prospective, nationwide, multicenter CAMI registry, of which 2,820 had diabetes, 2,011 had pre-diabetes, and 2,061 had normal glucose regulation (NGR). Patients were divided into high ABG and low ABG groups according to the optimal cutoff values of ABG to predict 2-year mortality for patients with diabetes, pre-diabetes and NGR, respectively. The primary endpoint was all-cause mortality.ResultsThe optimal cutoff values of ABG for predicting 2-year mortality was 9.0mmol/l, 7.2mmol/l and 6.2mmol/l for patients with diabetes, pre-diabetes and NGR, respectively. Overall, the risk of all-cause mortality in high ABG group was significantly increased compared with that in low ABG group among patients with diabetes (15.2% vs. 8.9%; hazard ratio [HR] 1.787, 95% confidence interval [CI] 1.413-2.260; P<0.0001), pre-diabetes (12.1% vs. 6.1%; HR 2.069, 95%CI 1.518-2.821; P<0.0001) and NGR (11.8% vs. 6.1%; HR 2.009, 95%CI 1.473-2.740; P<0.0001). After the potential confounders were adjusted, high ABG was significantly associated with higher risk of 2-year mortality in patients with diabetes (adjusted HR 1.710, 95%CI 1.327-2.203; P<0.0001), pre-diabetes (adjusted HR 1.731, 95%CI 1.249-2.399; P=0.001) and NGR (adjusted HR 1.529, 95%CI 1.110-2.106; P=0.009). Moreover, adding ABG to the original model led to a slight albeit significant improvement in C-statistic and net reclassification in patients with diabetes and NGR (all P<0.05).ConclusionsThis study is the first to demonstrate a strong positive association between ABG and 2-year mortality in AMI patients with diabetes, pre-diabetes and NGR. ABG should be considered as a useful marker for risk stratification in patients with diabetes and NGR. Further randomized trials are warranted to investigate the effects of blood glucose control on the reduction of long-term mortality according to the corresponding ABG thresholds for different glucose metabolism status.Clinical trial registrationClinicalTrials.gov, identifier NCT01874691.

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Dataset Information

Impact of blood glucose abnormalities on outcomes and disease severity in patients with severe sepsis: An analysis from a multicenter, prospective survey of severe sepsis.

Publications

Impact of blood glucose abnormalities on outcomes and disease severity in patients with severe sepsis: An analysis from a multicenter, prospective survey of severe sepsis.

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