Diabetes patients and non-diabetic patients intensive care unit and hospital mortality risks associated with sepsis  

作　　者：Chandler J Tayek John A Tayek 

机构地区：[1]Palos Verdes Pennisula High School [2]LaBioMedical Research and Education Institute,Harbor-UCLA Medical Center

出　　处：《World Journal of Diabetes》2012年第2期29-34,共6页世界糖尿病杂志（英文版）（电子版）

摘　　要：AIM: To compare mortality risks associated with known diabetic patients to hyperglycemic non-diabetic patients. METHODS: PubMed data base was searched for patients with sepsis, bacteremia, mortality and diabetes. Articles that also identified new onset hyperglycemia (NOH) (fasting blood glucose > 125 mg/dL or random blood glucose > 199 mg/dL were identified and reviewed. Nine studies were evaluated with regards to hyperglycemia and hospital mortality and five of the nine were summarized with regards to intensive care unit (ICU) mortality. RESULTS: Historically hyperglycemia has been believed to be equally harmful in known diabetic patients and non-diabetics patients admitted to hospital. Unexpectedly, having a history of diabetes when admitted to the hospital was associated with a reduced risk of hospital mortality. Approximately 17% of patients admitted to hospital have NOH and 24% have diabetes mellitus. Hospital mortality was significantly increased in all nine studies of patients with NOH as compared to known diabetic patients (26.7% ± 4.4% vs 12.5% ± 3.4%, P < 0.05; analysis of variance). Unadjusted ICU mortality was evaluated in five studies and was more than doubled for those patients with NOH as compared to known diabetic patients (25.3% ± 3.3% vs 12.8% ± 2.6%, P < 0.05) despite having similar blood glucose concentrations. Most importantly, having NOH was associated with an increased ICU and a 2.7-fold increase in hospital mortality when compared to hyperglycemic diabetic patients. The mortality benefit of being diabetic is unclear but may have to due with adaptation to hyperglycemia over time. Having a history of diabetes mellitus and prior episodes of hyperglycemia may provide time for the immune system to adapt to hyperglycemia and result in a reduced mortality risk. Understanding why diabetic patients have a lower than expected hospital mortality rate even with bacteremia or acute respiratory distress syndrome needs further study. CONCLUSION: Having hyperglycemia without a history of previous diab AIM:To compare mortality risks associated with known diabetic patients to hyperglycemic non-diabetic patients.METHODS:PubMed data base was searched for patients with sepsis,bacteremia,mortality and diabetes.Articles that also identified new onset hyperglycemia (NOH) (fasting blood glucose&gt;125 mg/dL or random blood glucose&gt;199 mg/dL) were identified and reviewed.Nine studies were evaluated with regards to hyperglycemia and hospital mortality and five of the nine were summarized with regards to intensive care unit (ICU) mortality.RESULTS:Historically hyperglycemia has been believed to be equally harmful in known diabetic patients and non-diabetics patients admitted to the hospital.Unexpectedly,having a history of diabetes when admitted to the hospital was associated with a reduced risk of hospital mortality.Approximately 17% of patients admitted to hospital have NOH and 24% have diabetes mellitus.Hospital mortality was significantly increased in all nine studies of patients with NOH as compared to known diabetic patients (26.7%±3.4% vs 12.5% ±3.4%,P&lt;0.05;analysis of variance).Unadjusted ICU mortality was evaluated in five studies and was more than doubled for those patients with NOH as compared to known diabetic patients (25.3%±3.3% vs 12.8%±2.6%,P&lt;0.05) despite having similar blood glucose concentrations.Most importantly,having NOH was associated with an increased ICU and a 2.7-fold increase in hospital mortality when compared to hyperglycemic diabetic patients.The mortality benefit of being diabetic is unclear but may have to do with adaptation to hyperglycemia over time.Having a history of diabetes mellitus and prior episodes of hyperglycemia may provide time for the immune system to adapt to hyperglycemia and result in a reduced mortality risk.Understanding why diabetic patients have a lower than expected hospital mortality rate even with bacteremia or acute respiratory distress syndrome needs further study.CONCLUSION:Having hyperglycemia without a history of previous diabetes mellitus is a maj

关 键 词：DIABETES BACTEREMIA SEPSIS INTENSIVE care unit MORTALITY Hospital MORTALITY 

分 类 号：R587.1[医药卫生—内分泌]