Glycated Hemoglobin < 6.5% Is Associated With Uroseptic Shock in Diabetic Patients With Urinary Tract Infection.

Yi-Chien Lee,Chih-Yen Hsiao,Meng-Chang Hsiao,Peir-Haur Hung,Shao-Hsien Tung,Tsung-Hsien Chen

doi:10.3389/fmed.2020.515506

Abstract

This study aimed to compare the clinical characteristics and treatment outcomes of diabetic and non-diabetic individuals with urinary tract infection (UTI) and determine whether glycated hemoglobin (HbA1c) levels <6. 5% leads to uroseptic shock in diabetic individuals. We retrospectively collected and analyzed the clinical data of 1,363 individuals with UTIs in Taiwan from January 2006 to January 2018. Of the 345 diabetic individuals, 61 (17.7%) developed uroseptic shock. Diabetic patients who developed uroseptic shock tended to be older and males and, had a history of congestive heart failure, urolithiasis, higher serum creatinine level during hospitalization, lower serum HbA1c level, bacteremia, and acute kidney injury. Backward stepwise multivariate logistic regression analysis showed that male gender [odds ratio (OR), 1.861; 95% confidence interval (CI), 1.009–3.433; P = 0.047], congestive heart failure (OR, 4.036; 95% CI, 1.542–10.565; P = 0.004), bacteremia (OR, 2.875; 95% CI, 1.539–5.370; P = 0.001), and HbA1c level <6.5% (OR, 2.923; 95% CI, 1.580–5.406; P = 0.001) were associated with an increased risk of developing uroseptic shock among diabetic patients during hospitalization due to UTI. HbA1c level <6.5% is independently associated with uroseptic shock in diabetic patients with UTI.

Highlights

Urinary tract infection (UTI) is one of the most prevalent infectious diseases in the general population, with an overall annual incidence of 17.5 per 1,000 population per year in Canada [1]
We found that patients in the diabetic group have distinct clinical manifestations of older age and multiple comorbidities
They were associated with worse laboratory profiles, including the development of bacteremia, increased isolates of Klebsiella spp., impaired renal function tests, lower hemoglobin level, and higher white blood cell (WBC) count

Summary

Introduction

Urinary tract infection (UTI) is one of the most prevalent infectious diseases in the general population, with an overall annual incidence of 17.5 per 1,000 population per year in Canada [1]. Urosepsis is a severe complication of UTI, accounting for 20–30% of all septic patients [2]. HbA1c in Urosepsis heart failure (CHF), and acute kidney injury (AKI) are associated with uroseptic shock in patients with UTI [5]. Previous studies have shown that diabetic individuals are susceptible to UTI [7, 8], which can be attributed to a weak immune system [9, 10], poor metabolic control [11, 12], and inadequate bladder emptying due to autonomic neuropathy [13, 14]. The impact of glycemic control on infection outcome, such as UTI with septic shock in diabetic individuals, is still unknown. We aimed to compare the clinical characteristics and treatment outcomes of diabetic and nondiabetic individuals with UTI and to determine whether HbA1c level < 6.5% is independently associated with uroseptic shock for diabetic individuals

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Conclusion