Admission Blood Glucose Is Associated With the 30-Days Mortality in Septic Patients: A Retrospective Cohort Study

Abstract

Background: Sepsis, as one of the severe diseases, is frequently observed in critically ill patients, especially concurrent with diabetes. Whether admission blood glucose is associated with the prognosis, and outcome of septic patients is still debatable.Methods: We retrospectively reviewed and analyzed the demographic characteristics of septic patients in the Medical Information Mart for Intensive Care III (MIMIC III, version 1.4) between June 2001 and October 2012. The Chi-square and Fisher's exact tests were used for the comparison of qualitative variables among septic patients with different glucose levels and the 30-day mortality in septic patients with diabetes or not. Univariate and stepwise multivariate Cox regression analyses were used to determine the risk factors for 30-day mortality. Kaplan-Meier analysis was conducted to reveal the different 30-day survival probabilities in each subgroup.Results: A total of 2,948 septic patients (910 cases with diabetes, 2,038 cases without diabetes) were ultimately included in the study. The 30-day mortality was 32.4% (956/2,948 cases) in the overall population without any difference among diabetic and non-diabetic septic patients (p = 1.000). Admission blood glucose levels <70 mg/dl were only observed to be significantly associated with the 30-day mortality of septic patients without diabetes (hazard ratio (HR) = 2.48, p < 0.001). After adjusting for confounders, age >65 years (HR = 1.53, p = 0.001), the Sequential Organ Failure Assessment (SOFA) score >5 (HR = 2.26, p < 0.001), lactic acid >2 mmol/L (Lac, HR = 1.35, p = 0.024), and platelet abnormality (<100 k/ul: HR = 1.49; >300 k/ul: HR = 1.36, p < 0.001) were the independent risk factors for 30-day mortality in septic patients with diabetes. In non-diabetes population, age >65 years (HR = 1.53, p < 0.001), non-White or non-Black patients (HR = 1.30, p = 0.004), SOFA score >5 (HR = 1.56, p < 0.001), blood glucose <70 mg/dl (HR = 1.91, p = 0.003), anion gap (AG) >2 mmol/L (HR = 1.60, p < 0.001), Lac (HR = 1.61, p < 0.001), urea nitrogen >21 mg/dl (HR = 1.45, p = 0.001), alanine aminotransferase (ALT, HR = 1.31, p = 0.009), total bilirubin >1.2 mg/dl (HR = 1.20, p = 0.033), and low hemoglobin (HR = 1.34, p = 0.001) were the independent risk factors for 30-day mortality.Conclusions: Our results indicate admission blood glucose, especially in terms of <70 mg/dl, is the key signaling in predicting the worse 30-day survival probability of septic patients without diabetes, which could help clinicians to make a more suitable and precise treatment modality in dealing with septic patients.

Association of preclinical blood glucose with hospitalization rate and in‐hospital mortality: A single‐center retrospective cohort study

“…22 Other studies in septic inpatients have shown that the mortality increases especially with very low or very high blood glucose levels. 22,31 The presented results are in concordance with earlier studies, showing elevated blood glucose to be associated with increased length of stay in the hospital, in-hospital complications, and mortality in the setting of general surgery. 4 Therefore, the detection of elevated PBG could be taken into account in the prognosis assessment of patients at risk as exemplified by the proposal to include fasting plasma glucose in the prediction of 90-day mortality in viral pneumonia.…”

“…As mortality seems to be stable in the present cohort at a PBG range between 140 and 180 mg/dL, a moderate elevation of PBG (<180 mg/dL) may not be as predictive of worse outcomes than higher PBG levels 22 . Other studies in septic inpatients have shown that the mortality increases especially with very low or very high blood glucose levels 22,31 . The presented results are in concordance with earlier studies, showing elevated blood glucose to be associated with increased length of stay in the hospital, in‐hospital complications, and mortality in the setting of general surgery 4 .…”

Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis

“…Nine studies set a cut-off value for high level blood lactate below 2 mmol/L [33,38,41,85,103,108,124,135,140], while 36 studies recognized the cut-off values for high level blood lactate between 2 and 4 mmol/L [6,11,15,16,34,35,39,43,50,52,53,64- In the pooled analysis, the recommended threshold for identifying the high level of blood lactate varied across the included studies. Nine studies set a cut-off value for high level blood lactate below 2 mmol/L [33,38,41,85,103,108,124,135,140], while 36 studies recognized the cut-off values for high level blood lactate between 2 and 4 mmol/L [6,11,15,16,34,35,39,43,50,52,53,[64][65][66][67][69][70][71][72]76,77,89,94,100,102,106,107,…”