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Influence of diabetes and HbA1c on the course and outcome of sepsis in the intensive care unit

Introduction

It is an accepted opinion that patients with diabetes mellitus (DM) are at higher risk when treated for infections, although published data are lacking. Our recent research on non-ICU septic patients showed that admission HbA1c is in correlation with outcome. The aim was to evaluate the impact of DM on the course and outcome of patients with sepsis in ICU, as well as to evaluate the value of HbA1c as an outcome predictor in the ICU.

Methods

In a prospective, 3-year observational study, patients with sepsis, severe sepsis and septic shock admitted to a medical ICU were included. Patients with DM were compared with nondiabetics in terms of course and outcome. HbA1c was measured for all patients with DM. Hospital mortality and length of stay (LOS) in the ICU and in hospital were the outcome measures. The incidence of organ failure, ARDS, hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were used as indicators of the disease course. Nonparametric tests, multiple regression and logistic regression were used in statistical analyses.

Results

Two hundred and twenty-nine patients with sepsis at admission (19.6% of all 1,169 ICU patients), 59 with DM, were included. Mortality in the ICU was 34.7%; the median ICU LOS was 8 (95% CI 7–9.3) days. Patient with DM, compared with nondiabetics, had higher mortality (38.9% vs 34.1%, P = 0.60) and longer ICU LOS (median 6 vs 10 days, P < 0.001), and higher incidence of renal failure, HAP, VAP. Surviving patients had significantly lower HbA1c levels (6.6 vs 9.6, P = 0.001). In a logistic regression, DM was found to be related to lethal outcome, together with APACHE II and SOFA scores. In multiple regression, DM related to LOS together with SOFA score and age. HbA1c was found to be independently related to ICU outcome together with SOFA score.

Conclusion

The ratio of patients with DM among ICU patients with sepsis exceeds greatly the incidence of DM in the population. This emphasizes the risk they have. DM was associated with worse outcome, longer ICU and hospital LOS, and with higher incidence of complications. HbA1c was confirmed as an outcome predictor for ICU patients.

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Gornik, I., Gornik, O. & Gasparovic, V. Influence of diabetes and HbA1c on the course and outcome of sepsis in the intensive care unit. Crit Care 11, P124 (2007). https://doi.org/10.1186/cc5284

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Keywords

  • Diabetes Mellitus
  • Septic Shock
  • Severe Sepsis
  • Hospital Mortality
  • HbA1c Level