The effect of diabetes mellitus on organ dysfunction with sepsis: an epidemiological study.
The effect of diabetes mellitus on organ dysfunction with sepsis: an epidemiological study.
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DOI：
10.1186/cc7717
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Martin GS
中科院分区：
文献类型：
--
作者：
Esper AM;Moss M;Martin GS
糖尿病(DM)是美国最常见的慢性合并症之一，常见于脓毒症患者。以前的研究报告称，患有糖尿病和严重脓毒症的人发生急性肺损伤(ALI)的可能性较小。我们试图确定患有和不患有糖尿病和脓毒症的人之间的器官功能障碍是否不同。使用美国国家医院出院调查，从1979年到2003年的脓毒症病例与疾病控制和预防中心(CDC)糖尿病监测系统的糖尿病患病率相结合。在研究期间，确认了9.3亿急性护理住院和1430万糖尿病患者。脓毒症发生在1250万次住院治疗中，17%的脓毒症患者出现糖尿病。在人群中，急性呼吸衰竭是最常见的器官功能障碍(13%)，其次是急性肾功能衰竭(6%)。糖尿病患者发生急性呼吸衰竭的可能性较小(9%比14%，p<；0.05)，发生急性肾功能衰竭的可能性更大(13%比7%，p<；0.05)。在患有糖尿病和脓毒症的患者中，27%的患者有呼吸道感染源，而在没有糖尿病的患者中，这一比例为34%(p<；0.05)。在肺源性败血症患者中，16%的糖尿病患者和23%的非糖尿病患者发生急性呼吸衰竭(p<；0.05)；在非肺性脓毒症患者中，6%的糖尿病患者和10%的非糖尿病患者发生急性呼吸衰竭(p<；0.05)。在脓毒症中，无论感染源如何，糖尿病患者发生急性呼吸衰竭的可能性都较小。未来的研究应该确定这些发现与降低糖尿病患者ALI风险的关系及其致病机制。
Diabetes mellitus (DM) is one of the most common chronic co-morbid medical conditions in the USA and is frequently present in patients with sepsis. Previous studies reported that people with DM and severe sepsis are less likely to develop acute lung injury (ALI). We sought to determine whether organ dysfunction differed between people with and without DM and sepsis. Using the National Hospital Discharge Survey US, sepsis cases from 1979 to 2003 were integrated with DM prevalence from the Centers for Disease Control and Prevention (CDC) Diabetes Surveillance System. During the study period 930 million acute-care hospitalisations and 14.3 million people with DM were identified. Sepsis occurred in 12.5 million hospitalisations and DM was present in 17% of patients with sepsis. In the population, acute respiratory failure was the most common organ dysfunction (13%) followed by acute renal failure (6%). People with DM were less likely to develop acute respiratory failure (9% vs. 14%, p < 0.05) and more likely to develop acute renal failure (13% vs. 7%, p < 0.05). Of people with DM and sepsis, 27% had a respiratory source of infection compared with 34% in people with no DM (p < 0.05). Among patients with a pulmonary source of sepsis, 16% of those with DM and 23% of those with no DM developed acute respiratory failure (p < 0.05); in non-pulmonary sepsis acute respiratory failure occurred in 6% of people with DM and 10% in those with no DM (p < 0.05). In sepsis, people with diabetes are less likely to develop acute respiratory failure, irrespective of source of infection. Future studies should determine the relationship of these findings to reduced risk of ALI in people with DM and causative mechanisms.
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