Incidence and Impact of Dysglycemia in Patients with Sepsis Under Moderate Glycemic Control.

Aged Aged, 80 and over Blood Glucose / metabolism Cohort Studies Diabetes Complications / blood Female Glycemic Control Hospital Mortality Hospitalization Humans Hyperglycemia / complications Hypoglycemia / complications Hypoglycemic Agents / therapeutic use Incidence Male Middle Aged Sepsis / blood

Journal

Shock (Augusta, Ga.)

ISSN: 1540-0514

Titre abrégé: Shock

Pays: United States

ID NLM: 9421564

Informations de publication

Date de publication:
01 10 2021

Historique:

pubmed: 13 5 2021

medline: 16 3 2022

entrez: 12 5 2021

Statut: ppublish

Résumé

Glycemic control strategies for sepsis have changed significantly over the last decade, but their impact on dysglycemia and its associated outcomes has been poorly understood. In addition, there is controversy regarding the detrimental effects of hyperglycemia in sepsis. To evaluate the incidence and risks of dysglycemia under current strategy, we conducted a preplanned subanalysis of the sepsis cohort in a prospective, multicenter FORECAST study. A total of 1,140 patients with severe sepsis, including 259 patients with pre-existing diabetes, were included. Median blood glucose levels were approximately 140 mg/dL at 0 and 72 h indicating that blood glucose was moderately controlled. The rate of initial and late hyperglycemia was 27.3% and 21.7%, respectively. The rate of early hypoglycemic episodes during the initial 24 h was 13.2%. Glycemic control was accompanied by a higher percentage of initial and late hyperglycemia but not with early hypoglycemic episodes, suggesting that glycemic control was targeted at excess hyperglycemia. In nondiabetic patients, late hyperglycemia (hazard ratio, 95% confidence interval; P value: 1.816, 1.116-2.955, 0.016) and early hypoglycemic episodes (1.936, 1.180-3.175, 0.009) were positively associated with in-hospital mortality. Further subgroup analysis suggested that late hyperglycemia and early hypoglycemic episodes independently, and probably synergistically, affect the outcomes. In diabetic patients, however, these correlations were not observed. In conclusion, a significantly high incidence of dysglycemia was observed in our sepsis cohort under moderate glycemic control. Late hyperglycemia in addition to early hypoglycemia was associated with poor outcomes at least in nondiabetic patients. More sophisticated approaches are necessary to reduce the incidence of these serious complications.

Identifiants

DOI: 10.1097/SHK.0000000000001794 PMID: 33978606

pubmed: 33978606

doi: 10.1097/SHK.0000000000001794

pii: 00024382-202110000-00004

doi:

Substances chimiques

Blood Glucose 0

Hypoglycemic Agents 0

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

507-513

Informations de copyright

Déclaration de conflit d'intérêts

The other authors report no conflicts of interest.

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