Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Diabetes. Feb 15, 2012; 3(2): 29-34
Published online Feb 15, 2012. doi: 10.4239/wjd.v3.i2.29
Diabetes patients and non-diabetic patients intensive care unit and hospital mortality risks associated with sepsis
Chandler J Tayek, John A Tayek
Chandler J Tayek, Palos Verdes Pennisula High School, Rolling Hills Estates, CA 90274, United States
John A Tayek, LaBioMedical Research and Education Institute, Harbor-UCLA Medical Center, 1000 W Carson Street, PO Box 428, Torrance, CA 90509, United States
Author contributions: Tayek JA performed study design, data analysis and wrote part of manuscript; Tayek CJ wrote part of manuscript and edited the revised manuscript.
Correspondence to: John A Tayek, MD, Professor of Medicine in Residence, LaBioMedical Research and Education Institute, Harbor-UCLA Medical Center, 1000 W Carson Street, PO Box 428, Torrance, CA 90509, United States. jtayek@ladhs.org
Telephone: +1-310-2221237 Fax: +1-310-3208459
Received: August 24, 2011
Revised: January 6, 2012
Accepted: February 8, 2012
Published online: February 15, 2012
Abstract

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 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 < 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 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 major independent risk factor for ICU and hospital mortality.

Keywords: Diabetes; Bacteremia; Sepsis; Intensive care unit mortality; Hospital mortality