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Diabetes Is Not Associated With Increased 90-Day Mortality Risk in Critically Ill Patients With Sepsis

van Vught, Lonneke A. MD1,2; Holman, Rebecca PhD3,4; de Jonge, Evert MD, PhD4,5; de Keizer, Nicolette F. PhD3,4; van der Poll, Tom MD, PhD1,2,6

doi: 10.1097/CCM.0000000000002590
Online Clinical Investigations

Objectives: To determine the association of pre-existing diabetes, hyperglycemia, and hypoglycemia during the first 24 hours of ICU admissions with 90-day mortality in patients with sepsis admitted to the ICU.

Design: We used mixed effects logistic regression to analyze the association of diabetes, hyperglycemia, and hypoglycemia with 90-day mortality (n = 128,222).

Setting: All ICUs in the Netherlands between January 2009 and 2014 that participated in the Dutch National Intensive Care Evaluation registry.

Patients: All unplanned ICU admissions in patients with sepsis.

Interventions: The association between 90-day mortality and pre-existing diabetes, hyperglycemia, and hypoglycemia, corrected for other factors, was analyzed using a generalized linear mixed effect model.

Measurements and Main Results: In a multivariable analysis, diabetes was not associated with increased 90-day mortality. In diabetes patients, only severe hypoglycemia in the absence of hyperglycemia was associated with increased 90-day mortality (odds ratio, 2.95; 95% CI, 1.19–7.32), whereas in patients without pre-existing diabetes, several combinations of abnormal glucose levels were associated with increased 90-day mortality.

Conclusions: In the current retrospective large database review, diabetes was not associated with adjusted 90-day mortality risk in critically ill patients admitted with sepsis.

1Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

2Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

3Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

4NICE foundation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

5Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands.

6Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Holman’s institution received funding from the National Intensive Care Evaluation (NICE) Foundation for maintaining the national database, providing feedback reports, and doing analyses, and she disclosed other employment by the Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands and by the Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands. Dr. de Keizer’s institution received funding from the NICE Foundation, and she disclosed that she is a board member of the NICE Foundation. Drs. de Jonge and de Keizer are board members of the NICE foundation. The institution of Drs. Holamn and de Keizer received grant support, support for travel, provision of funds for data managers, and support for the development of educational presentations from the NICE foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

This study was performed at Academic Medical Center, at Center for Experimental and Molecular Medicine, and at the Department of Medical Informatics (Amsterdam, the Netherlands).

For information regarding this article, E-mail: l.a.vanvught@amc.uva.nl

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