Stress-induced Hyperglycemia in Patients With Severe Sepsis: A Compromising Factor for Survival
Stress-induced Hyperglycemia in Patients With Severe Sepsis: A Compromising Factor for Survival
复制标题
DOI：
10.1097/maj.0b013e318176abb4
复制
发表时间：
2008-12-01
影响因子：
3.1
通讯作者：
Gogos, Charalambos A.
中科院分区：
文献类型：
--
作者：
Leonidou, Leonidia;Michalaki, Marina;Gogos, Charalambos A.
目的：研究严重脓毒症伴基线高血糖患者的临床和实验室特征，探讨高血糖对最终结局的影响。患者：在1年期间，希腊西南部3家主要医院共收治了265例严重脓毒症患者，纳入本研究。根据入院时血糖水平将患者分为3组：应激性高血糖患者（SH组，n = 47）、糖尿病患者（DM组，n = 65）和血糖水平正常的患者（NG组，n = 153）。高血糖定义为入院或住院时空腹血糖水平>= 126 mg/dL或随机血糖水平>= 2次测定>= 200 mg/dL。结果：42.2%的严重脓毒症患者有基线高血糖，17.7%的患者有脓毒症诱导的应激性高血糖。SH组无家族史。与血糖正常的患者（42.5%对13.7%）和糖尿病患者（42.5%对24.6%）相比，脓毒症伴应激性高血糖患者的死亡率更高。DM组的预后也比NG组差（24.6%比13.7%）。SH组空腹血糖水平与脓毒症相关器官衰竭评分的严重程度呈正相关。结论：基线高血糖，包括应激诱导的高血糖，在严重脓毒症患者中很常见。应激诱发的高血糖与更严重的疾病和更差的预后有关。
Objective: To study the clinical and laboratory characteristics of patients with severe sepsis and basefine hyperglycemia and investigate the impact of hyperglycemia on the final Outcome. Patients: A total of 265 patients admitted with severe sepsis in 3 major hospitals in South-Western Greece, during a 1-year period, were included in the study. Patients were divided in 3 groups according to their glycemic profile at admission: patients with stress hyperglycemia (group) SH, n = 47), with diabetes mellitus (group DM, n = 65), and with normal glucose level (group NG, n = 153). Hyperglycemia was defined as an admission or in-hospital fasting glucose level of; >= 126 mg/dL or a random blood glucose level of 200 mg/dL on >= 2 determinations. Results: A total of 42.2% of patients with severe sepsis had baseline hyperglycemia with 17.7% having sepsis-induced stress hyperglycemia. No family history was noted in the SH group. A higher percentage of septic patients with stress hyperglycemia died compared with patients with normal glucose levels (42.5%, versus 13.7%) and diabetics (42.5%, versus 24.6%). Group DM had also a poorer prognosis than group NG (24.6'% versus 13.7%)). A positive correlation was detected between the fasting blood glucose levels of group SH and the severity of sepsis indicated by sepsis-related organ failure assessment score. Conclusion: Baseline hyperglycemia, including stress-induced hyperglycemia, is common in patients with severe sepsis. Stress-induced hyperglycemia is related to a more severe disease and poorer prognosis.