Impact of serum glucose levels on disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis.

AIM

To determine whether glycemic abnormality and pre-existing diabetes are associated with disease severity and mortality in patients with severe sepsis.

METHODS

Six hundred and nineteen patients with severe sepsis were grouped into four categories according to their blood glucose levels (<100, 100-199, 200-299, and ≥300 mg/dL). We compared disease severity and mortality between glycemic categories. In addition, we examined whether there was any relationship with pre-existing diabetes status.

RESULTS

There were no significant differences in disseminated intravascular coagulation, Sequential Organ Failure Assessment, or Acute Physiology and Chronic Health Evaluation II scores and mortality rates between patients with or without pre-existing diabetes. However, in patients without pre-existing diabetes, those with blood glucose level <100 mg/dL had higher disseminated intravascular coagulation, Sequential Organ Failure Assessment, and Acute Physiology and Chronic Health Evaluation II scores than those with levels of 100-299 mg/dL. In addition, those with level ≥300 mg/dL had a higher hospital mortality rate than those with levels of 100-199 mg/dL (odds ratio = 4.837). Multivariate logistic regression analysis revealed that a blood glucose level ≥300 mg/dL is an independent predictor of hospital mortality in these patients. In contrast, no significant differences among severity scores or mortality were observed in patients with pre-existing diabetes.

CONCLUSIONS

In patients with severe sepsis, the impact of glycemic abnormality on disease severity and hospital mortality depends on the pre-existing diabetes status. Specifically, a blood glucose level ≥300 mg/dL may be associated with increased mortality in patients without pre-existing diabetes.