糖尿病酮症酸中毒和高渗高血糖综合征中感染的流行病学、微生物学和诊断：一项多中心回顾性观察研究。

Epidemiology, microbiology, and diagnosis of infection in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: A multicenter retrospective observational study.

机构信息

Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-city, Saitama 330-0834, Japan; Department of Anesthesiology and Critical Care Medicine, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan.

Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.

出版信息

Diabetes Res Clin Pract. 2024 Jun;212:111713. doi: 10.1016/j.diabres.2024.111713. Epub 2024 May 19.

DOI:10.1016/j.diabres.2024.111713

PMID:38772502

Abstract

AIMS

We investigated the characteristics of infection and the utility of inflammatory markers in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS).

METHODS

A multicenter, retrospective observational study in 21 acute-care hospitals was conducted in Japan. This study included adult hospitalized patients with DKA and HHS. We analyzed the diagnostic accuracy of markers including C-reactive protein (CRP) and procalcitonin (PCT) for bacteremia. Multiple regression models were created for estimating bacteremia risk factors.

RESULTS

A total of 771 patients, including 545 patients with DKA and 226 patients with HHS, were analyzed. The mean age was 58.2 (SD, 19.3) years. Of these, 70 tested positive for blood culture. The mortality rates of those with and without bacteremia were 14 % and 3.3 % (P-value < 0.001). The area under the curve (AUC) of CRP and PCT for diagnosis of bacteremia was 0.85 (95 %CI, 0.81-0.89) and 0.76 (95 %CI, 0.60-0.92), respectively. Logistic regression models identified older age, altered level of consciousness, hypotension, and higher CRP as risk factors for bacteremia.

CONCLUSIONS

The mortality rate was higher in patients with bacteremia than patients without it. CRP, rather than PCT, may be valid for diagnosing bacteremia in hyperglycemic emergencies.

TRIAL REGISTRATION

This study is registered in the UMIN clinical trial registration system (UMIN000025393, Registered December 23, 2016).

摘要

目的

我们研究了感染特征以及炎症标志物在糖尿病酮症酸中毒（DKA）和高渗高血糖综合征（HHS）中的应用。

方法

在日本的 21 家急性护理医院进行了一项多中心、回顾性观察性研究。本研究纳入了 DKA 和 HHS 的成年住院患者。我们分析了 C 反应蛋白（CRP）和降钙素原（PCT）等标志物对菌血症的诊断准确性。建立了多个回归模型来估计菌血症的危险因素。

结果

共分析了 771 例患者，其中 545 例为 DKA，226 例为 HHS。患者的平均年龄为 58.2（SD，19.3）岁。其中 70 例血培养阳性。菌血症患者和非菌血症患者的死亡率分别为 14%和 3.3%（P 值<0.001）。CRP 和 PCT 对菌血症诊断的曲线下面积（AUC）分别为 0.85（95%CI，0.81-0.89）和 0.76（95%CI，0.60-0.92）。Logistic 回归模型确定年龄较大、意识改变、低血压和 CRP 水平升高是菌血症的危险因素。