HbA1c Levels Predict Sepsis Outcome in Diabetes

Hemoglobin A_1c levels at hospital admission are predictive for hospital mortality and length of stay in diabetic patients with sepsis, reported Dr. Ivan Gornik of Rebro University Hospital in Zagreb, Croatia, and associates.

The investigators conducted a prospective, observational study of adults with type 2 diabetes admitted to a medical ward or medical intensive care unit because of sepsis. APACHE II and sequential organ failure assessment (SOFA) scores, plasma glucose levels, C-reactive protein (CRP), and leukocyte counts were determined upon hospital admission. HbA_1c levels were determined the following day.

The study was conducted from November 2003 to December 2005 and enrolled 286 adults, of which 121 (42%) were female. A total of 224 patients survived, with a median length of stay of 9 days (range 7–13). Of the 62 patients (22%) who died in the hospital, 32 (52%) were female.

Survivors were significantly younger than nonsurvivors were and had better APACHE II and SOFA scores. Median ages of survivors and nonsurvivors were 61 years (range 38–72) and 66 years (range 48–76), respectively (Diab. Res. Clin. Pract. 2006 [Epub doi:10.1016/j.diabres.2006.10.017]).

Survivors had significantly lower HbA_1c values (median 8.2%) than did nonsurvivors (median 9.75%).

In multivariate logistic regression analysis, HbA_1c level was an independent predictor of hospital mortality, with an adjusted odds ratio of 1.358 for each increase of 1%. In the same analysis, female gender, APACHE II score, and SOFA score were also independent predictors of hospital mortality, whereas age, plasma glucose levels at admission, and CRP were not.

Receiver operating curves analysis showed HbA_1c levels in survivors to be significantly correlated with length of hospital stay. HbA_1c scores did not correlate with plasma glucose levels, CRP, leukocyte count, age, APACHE II scores, or SOFA scores.

All patients with type 2 diabetes and sepsis should have strict glucose control, advised Dr. Gornik.

There is no additional treatment that can be offered to the subset of those patients with diabetes and sepsis who have high HbA_1c levels, but awareness of their condition might facilitate earlier detection and treatment of complications, he said.

Hemoglobin A_1c levels at hospital admission are predictive for hospital mortality and length of stay in diabetic patients with sepsis, reported Dr. Ivan Gornik of Rebro University Hospital in Zagreb, Croatia, and associates.

The investigators conducted a prospective, observational study of adults with type 2 diabetes admitted to a medical ward or medical intensive care unit because of sepsis. APACHE II and sequential organ failure assessment (SOFA) scores, plasma glucose levels, C-reactive protein (CRP), and leukocyte counts were determined upon hospital admission. HbA_1c levels were determined the following day.

The study was conducted from November 2003 to December 2005 and enrolled 286 adults, of which 121 (42%) were female. A total of 224 patients survived, with a median length of stay of 9 days (range 7–13). Of the 62 patients (22%) who died in the hospital, 32 (52%) were female.

Survivors were significantly younger than nonsurvivors were and had better APACHE II and SOFA scores. Median ages of survivors and nonsurvivors were 61 years (range 38–72) and 66 years (range 48–76), respectively (Diab. Res. Clin. Pract. 2006 [Epub doi:10.1016/j.diabres.2006.10.017]).

Survivors had significantly lower HbA_1c values (median 8.2%) than did nonsurvivors (median 9.75%).

In multivariate logistic regression analysis, HbA_1c level was an independent predictor of hospital mortality, with an adjusted odds ratio of 1.358 for each increase of 1%. In the same analysis, female gender, APACHE II score, and SOFA score were also independent predictors of hospital mortality, whereas age, plasma glucose levels at admission, and CRP were not.

Receiver operating curves analysis showed HbA_1c levels in survivors to be significantly correlated with length of hospital stay. HbA_1c scores did not correlate with plasma glucose levels, CRP, leukocyte count, age, APACHE II scores, or SOFA scores.

All patients with type 2 diabetes and sepsis should have strict glucose control, advised Dr. Gornik.

There is no additional treatment that can be offered to the subset of those patients with diabetes and sepsis who have high HbA_1c levels, but awareness of their condition might facilitate earlier detection and treatment of complications, he said.

Hemoglobin A_1c levels at hospital admission are predictive for hospital mortality and length of stay in diabetic patients with sepsis, reported Dr. Ivan Gornik of Rebro University Hospital in Zagreb, Croatia, and associates.

The investigators conducted a prospective, observational study of adults with type 2 diabetes admitted to a medical ward or medical intensive care unit because of sepsis. APACHE II and sequential organ failure assessment (SOFA) scores, plasma glucose levels, C-reactive protein (CRP), and leukocyte counts were determined upon hospital admission. HbA_1c levels were determined the following day.

The study was conducted from November 2003 to December 2005 and enrolled 286 adults, of which 121 (42%) were female. A total of 224 patients survived, with a median length of stay of 9 days (range 7–13). Of the 62 patients (22%) who died in the hospital, 32 (52%) were female.

Survivors were significantly younger than nonsurvivors were and had better APACHE II and SOFA scores. Median ages of survivors and nonsurvivors were 61 years (range 38–72) and 66 years (range 48–76), respectively (Diab. Res. Clin. Pract. 2006 [Epub doi:10.1016/j.diabres.2006.10.017]).

Survivors had significantly lower HbA_1c values (median 8.2%) than did nonsurvivors (median 9.75%).

In multivariate logistic regression analysis, HbA_1c level was an independent predictor of hospital mortality, with an adjusted odds ratio of 1.358 for each increase of 1%. In the same analysis, female gender, APACHE II score, and SOFA score were also independent predictors of hospital mortality, whereas age, plasma glucose levels at admission, and CRP were not.

Receiver operating curves analysis showed HbA_1c levels in survivors to be significantly correlated with length of hospital stay. HbA_1c scores did not correlate with plasma glucose levels, CRP, leukocyte count, age, APACHE II scores, or SOFA scores.

All patients with type 2 diabetes and sepsis should have strict glucose control, advised Dr. Gornik.

There is no additional treatment that can be offered to the subset of those patients with diabetes and sepsis who have high HbA_1c levels, but awareness of their condition might facilitate earlier detection and treatment of complications, he said.