大肠杆菌菌血症发病时低血糖的预后价值。

Prognostic value of low blood glucose at the presentation of E. coli bacteremia.

作者信息

Alamgir Shamsuddin, Volkova Natalia B, Peterson Michael W

机构信息

Department of Medicine, UCSF Fresno Medical Education Program, Fresno, Calif 93702, USA.

出版信息

Am J Med. 2006 Nov;119(11):952-7. doi: 10.1016/j.amjmed.2006.03.035.

DOI:10.1016/j.amjmed.2006.03.035

PMID:17071163

Abstract

PURPOSE

Septicemia is the tenth leading cause of death in the United States, and Escherichia coli is the most common isolate in blood cultures. Low blood glucose is a known complication of sepsis. The prognostic role of low blood glucose in E. coli bacteremia is unknown. The study's objective was to identify the incidence of low blood glucose at the presentation of E. coli bacteremia and determine its influence on prognosis and outcome.

SUBJECTS AND METHODS

A retrospective cohort study was conducted in university-affiliated community hospitals. Subjects were consecutive patients diagnosed with E. coli bacteremia between 1997 and 2003. We identified 1060 patients with documented E. coli bacteremia. We excluded 105 patients who were younger than 18 years old or pregnant. We recorded demographic characteristics, discharge diagnosis, and outcome.

RESULTS

Among the 955 patients with E. coli bacteremia, the average age was 64+/-19.4 years. Overall, 4.6% had documented low blood glucose (blood glucose <70 mg/dL) at presentation. The incidence of low blood glucose was the same in diabetic and nondiabetic patients. Patients with low blood glucose had a 4.7 times higher risk of death compared to patients with non-low blood glucose. Race, age, sex, and diabetes had no influence on survival. Gastrointestinal and genitourinary sources for E. coli bacteremia were more commonly associated with low blood glucose (P <.001). The study was limited to E. coli-positive blood cultures and to the one hospital system.

CONCLUSIONS

Low blood glucose is present at the onset of E. coli bacteremia in 4.6% of patients. This represents a potentially large number of patients because E. coli is the most common blood culture isolate. Low blood glucose predicts poor outcome, especially in patients with abnormal hepatic and renal function. Low blood glucose should be considered an early clinical sign of E. coli bacteremia and aggressive therapy should be instituted to potentially save lives.

摘要

目的

败血症是美国第十大致死原因，而大肠杆菌是血培养中最常见的分离菌。低血糖是败血症已知的并发症。低血糖在大肠杆菌菌血症中的预后作用尚不清楚。本研究的目的是确定大肠杆菌菌血症发病时低血糖的发生率，并确定其对预后和结局的影响。

受试者与方法

在大学附属医院进行了一项回顾性队列研究。受试者为1997年至2003年间连续诊断为大肠杆菌菌血症的患者。我们确定了1060例有记录的大肠杆菌菌血症患者。我们排除了105例年龄小于18岁或怀孕的患者。我们记录了人口统计学特征、出院诊断和结局。

结果

在955例大肠杆菌菌血症患者中，平均年龄为64±19.4岁。总体而言，4.6%的患者在发病时有记录的低血糖（血糖<70mg/dL）。糖尿病患者和非糖尿病患者的低血糖发生率相同。低血糖患者的死亡风险是非低血糖患者的4.7倍。种族、年龄、性别和糖尿病对生存没有影响。大肠杆菌菌血症的胃肠道和泌尿生殖系统来源更常与低血糖相关（P<.001）。该研究仅限于大肠杆菌阳性血培养和一个医院系统。