Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Crit Care. 2023 Jul 31;27(1):302. doi: 10.1186/s13054-023-04586-4.
Sepsis survivors are at elevated risk for cardiovascular disease during long-term follow-up. Whether diabetes influences cardiovascular risk after sepsis survival remains unknown. We sought to describe the association of diabetes with long-term cardiovascular outcomes in adult sepsis survivors.
Population-based cohort study in the province of Ontario, Canada (2008-2017). Adult survivors of a first sepsis-associated hospitalization, without pre-existing cardiovascular disease, were included. Main exposure was pre-existing diabetes (any type). The primary outcome was the composite of myocardial infarction, stroke, and cardiovascular death. Patients were followed up to 5 years from discharge date until outcome occurrence or end of study period (March 2018). We used propensity score matching (i.e., 1:1 to patients with sepsis but no pre-existing diabetes) to adjust for measured confounding at baseline. Cause-specific Cox proportional hazards models with robust standard errors were used to estimate hazard ratios (HR) alongside 95% confidence intervals (CI). A main secondary analysis evaluated the modification of the association between sepsis and cardiovascular disease by pre-existing diabetes.
78,638 patients with pre-existing diabetes who had a sepsis-associated hospitalization were matched to patients hospitalized for sepsis but without diabetes. Mean age of patients was 71 years, and 55% were female. Median duration from diabetes diagnosis was 9.8 years; mean HbA1c was 7.1%. Adult sepsis survivors with pre-existing diabetes experienced a higher hazard of major cardiovascular disease (HR 1.25; 95% CI 1.22-1.29)-including myocardial infarction (HR 1.40; 95% CI 1.34-1.47) and stroke (HR 1.24; 95% CI 1.18-1.29)-during long-term follow-up compared to sepsis survivors without diabetes. Pre-existing diabetes modified the association between sepsis and cardiovascular disease (risk difference: 2.3%; 95% CI 2.0-2.6 and risk difference: 1.8%; 95% CI 1.6-2.0 for the effect of sepsis-compared to no sepsis-among patients with and without diabetes, respectively).
Sepsis survivors with pre-existing diabetes experience a higher long-term hazard of major cardiovascular events when compared to sepsis survivors without diabetes. Compared to patients without sepsis, the absolute risk increase of cardiovascular events after sepsis is higher in patients with diabetes (i.e., diabetes intensified the higher cardiovascular risk induced by sepsis).
脓毒症幸存者在长期随访中患心血管疾病的风险增加。糖尿病是否会影响脓毒症存活者的心血管风险尚不清楚。我们旨在描述糖尿病与成人脓毒症幸存者的长期心血管结局之间的关联。
这是一项在加拿大安大略省进行的基于人群的队列研究（2008-2017 年）。纳入了首次脓毒症相关住院治疗且无预先存在心血管疾病的成年幸存者。主要暴露因素为预先存在的糖尿病（任何类型）。主要结局是心肌梗死、卒中和心血管死亡的复合事件。患者在出院日期后随访 5 年，直至发生结局或研究期结束（2018 年 3 月）。我们使用倾向评分匹配（即 1:1 匹配患有脓毒症但无预先存在糖尿病的患者）来调整基线时的测量混杂因素。使用具有稳健标准差的特定原因 Cox 比例风险模型来估计风险比（HR）及其 95%置信区间（CI）。主要的次要分析评估了预先存在的糖尿病对脓毒症与心血管疾病之间关联的修饰作用。
共有 78638 例患有预先存在糖尿病的患者因脓毒症相关住院而接受治疗，这些患者与因脓毒症住院但无糖尿病的患者相匹配。患者的平均年龄为 71 岁，55%为女性。从糖尿病诊断到中位时间为 9.8 年；平均 HbA1c 为 7.1%。与无糖尿病的脓毒症幸存者相比，患有预先存在糖尿病的成年脓毒症幸存者在长期随访中经历主要心血管疾病的风险更高（HR 1.25；95%CI 1.22-1.29），包括心肌梗死（HR 1.40；95%CI 1.34-1.47）和卒中等（HR 1.24；95%CI 1.18-1.29）。预先存在的糖尿病修饰了脓毒症与心血管疾病之间的关联（风险差异：2.3%；95%CI 2.0-2.6 和风险差异：1.8%；95%CI 1.6-2.0，分别为在有和没有糖尿病的患者中，与无脓毒症相比，脓毒症的作用）。
与无糖尿病的脓毒症幸存者相比，患有预先存在糖尿病的脓毒症幸存者在长期随访中发生主要心血管事件的风险更高。与无脓毒症的患者相比，糖尿病患者发生心血管事件的绝对风险增加（即，糖尿病加剧了脓毒症引起的更高心血管风险）。
