Diabetic patients with severe sepsis admitted to intensive care unit do not fare worse than non-diabetic patients: a nationwide population-based cohort study.
Diabetic patients with severe sepsis admitted to intensive care unit do not fare worse than non-diabetic patients: a nationwide population-based cohort study.
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DOI：
10.1371/journal.pone.0050729
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Liu CE
中科院分区：
文献类型：
--
作者：
Chang CW;Kok VC;Tseng TC;Horng JT;Liu CE
我们试图研究2型糖尿病是否会增加急性器官功能障碍的风险，以及需要进入重症监护室（ICU）的严重脓毒症后的医院死亡率。在1998-2008年期间首次入住ICU的16，497例严重脓毒症受试者中开展的全国人群回顾性队列研究。然后创建糖尿病队列（n = 4573）和非糖尿病队列（n =11924）。 比较合并或不合并糖尿病的严重脓毒症患者器官功能障碍的相对风险（RR）、住院时间（LOS）、90天住院死亡率、ICU资源利用率和经年龄、性别、Charlson-Deyo合并症指数评分、手术条件和急性器官功能障碍数量校正的死亡率风险比（HR）。合并脓毒症的糖尿病患者发生急性肾损伤的风险更高（RR，1.54; 95%置信区间（CI），1.44-1.63），更可能在ICU接受血液透析（15.55% vs. 7.24%）。然而，糖尿病队列发生急性呼吸功能障碍（RR = 0.96，0.94-0.97）、血液功能障碍（RR = 0.70，0.56-0.89）和肝功能障碍（RR = 0.77，0.63-0.93）的风险较低。 在90天住院死亡率的校正HR方面，合并严重脓毒症的糖尿病患者在患有心血管、呼吸、肝、肾和/或神经系统器官功能障碍以及器官功能障碍的数量时并没有显著恶化。两个队列之间的LOS无统计学显著差异（中位数17 vs. 16天，四分位距（IQR）8-30天，p = 0.11）。 预测死亡率发生的多元logistic回归分析显示，糖尿病不是预测因素，比值比为0.972，95%CI 0.890-1.061，p = 0.5203。 这项大型的全国性人群队列研究表明，糖尿病患者在患有需要ICU入院的严重脓毒症时，其情况并不比非糖尿病患者差。
We sought to examine whether type 2 diabetes increases the risk of acute organ dysfunction and of hospital mortality following severe sepsis that requires admission to an intensive care unit (ICU). Nationwide population-based retrospective cohort study of 16,497 subjects with severe sepsis who had been admitted for the first time to an ICU during the period of 1998–2008. A diabetic cohort (n = 4573) and a non-diabetic cohort (n = 11924) were then created. Relative risk (RR) of organ dysfunctions, length of hospital stay (LOS), 90-days hospital mortality, ICU resource utilization and hazard ratio (HR) of mortality adjusted for age, gender, Charlson-Deyo comorbidity index score, surgical condition and number of acute organ dysfunction, were compared across patients with severe sepsis with or without diabetes. Diabetic patients with sepsis had a higher risk of developing acute kidney injury (RR, 1.54; 95% confidence interval (CI), 1.44–1.63) and were more likely to be undergoing hemodialysis (15.55% vs. 7.24%) in the ICU. However, the diabetic cohort had a lower risk of developing acute respiratory dysfunction (RR = 0.96, 0.94–0.97), hematological dysfunction (RR = 0.70, 0.56–0.89), and hepatic dysfunction (RR = 0.77, 0.63–0.93). In terms of adjusted HR for 90-days hospital mortality, the diabetic patients with severe sepsis did not fare significantly worse when afflicted with cardiovascular, respiratory, hepatic, renal and/or neurologic organ dysfunction and by numbers of organ dysfunction. There was no statistically significant difference in LOS between the two cohorts (median 17 vs. 16 days, interquartile range (IQR) 8–30 days, p = 0.11). Multiple logistic regression analysis to predict the occurrence of mortality shows that being diabetic was not a predictive factor with an odds ratio of 0.972, 95% CI 0.890–1.061, p = 0.5203. This large nationwide population-based cohort study suggests that diabetic patients do not fare worse than non-diabetic patients when suffering from severe sepsis that requires ICU admission.