Sepsis patients with diabetes are significantly less likely to experience acute respiratory failure than are patients without diabetes, according to data from a review of 930 million hospitalizations over 25 years.
Previous studies have shown that sepsis is common in people with diabetes, and that those patients are less likely to develop acute lung injuries as a result of sepsis. But those studies did not compare organ dysfunction in sepsis patients with and without diabetes.
Dr. Annette Esper of Emory University in Atlanta and her colleagues reviewed National Hospital Discharge Survey data from 1979-2003. The researchers used ICD-9 codes to identify cases of sepsis and the sources of the infections. The researchers identified 12.5 million cases of sepsis, and 17% of the patients had diabetes. Among the population of patients with diabetes and sepsis, 57% were women, and 64% were white. The average patient age was 68 years.
Overall, patients with diabetes and sepsis were significantly more likely to develop acute renal failure than were patients without diabetes, but were significantly less likely to develop acute respiratory failure (see chart) (Crit. Care 2009 Feb. 12 [doi: 10.1186/cc7717]).
No other significant differences appeared in the occurrence of other organ dysfunctions, or in the average total number of organ dysfunctions in the two groups. However, the difference in acute respiratory failure persisted regardless of the source of infection. Among patients with a respiratory source of sepsis, those with diabetes were significantly less likely to develop acute respiratory failure than were those without diabetes (16% vs. 23%). The difference in acute respiratory failure rates was also significant for patients with and without diabetes (6% vs. 10%) who had nonpulmonary sources of infection.
The overall fatality rate for sepsis patients with diabetes was significantly lower than for those without diabetes (19% vs. 21%), but fatality rates between patients with and without diabetes who developed acute respiratory failure were not significantly different (52% vs. 48%).
The reasons for the distinction in respiratory failure rates between patients with and without diabetes remain uncertain. Theories include the potential blunted inflammatory response to organ dysfunction in people with diabetes, the investigators said, and the possibility that diabetes patients may be hospitalized for sepsis sooner because they may be more alert to signs of infection. Diabetes medications may play a role, too.
“Pharmacological aspects of [diabetes] may also influence the development of organ dysfunction, because many medications administered to patients with [diabetes], including insulin and thiazolidinediones, are known to have anti-inflammatory effects in addition to lowering blood glucose,” the researchers noted.
But more research is needed to show the effects of diabetes medications and other factors on respiratory problems in sepsis patients in order to develop more effective treatments, they added.
The researchers had no financial conflicts to disclose.
Elsevier Global Medical News