IMPACT OF TYPE II DIABETES MELLITUS ON SHORT-TERM IN-HOSPITAL OUTCOMES OF SEPSIS ADMISSIONS

Abstract

SESSION TITLE: Critical Care 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Type II diabetes mellitus is a proinflammatory state which increases susceptibility for severe infections. Sepsis activates a proinflammatory pathway within the body causing an increased cortisol response. When left unchecked, a cytokine storm subsequently causes multiorgan failure and death. The NICE-SUGAR trial demonstrated a liberal blood sugar control to reduce mortality in critically ill patients, however subgroup analysis showed the liberal blood sugar control group to have increased incidence of infections. The prevalence of diabetes and pre-hospitalization glycemic control are considered here to be individual factors to help predict sepsis outcomes. This study seeks to examine the effects of diabetes on sepsis admissions by examining short-term in-hospital outcomes and rate of organ failure. METHODS: This retrospective cohort study utilized information from the 2012-2014 Nationwide Inpatient Sample (NIS) to identify adult patients (18+ years) with a primary diagnosis of septicemia, septicemic, bacteremia, disseminated fungal infection, disseminated candida infection, or disseminated fungal endocarditis. Selected patients were analyzed for type II diabetes mellitus. Exclusions included patients with diabetes with ketoacidosis or hyperosmolarity, diabetic coma, type I diabetes, or patients missing important clinical identifiers. RESULTS: 648,602 sepsis admissions were identified including 205,749 with type II diabetes and 442,853 without type II diabetes. Increased mortality was observed in the non-diabetic patients (13.4% vs 11.1%, p<.001, OR .81, CI .80-.82), while patients with type II diabetes had increased LOS (7.7 vs 7.6 days, p<.001), age at admission (68.7 vs 65.7 years, p<.001), and number of chronic conditions (8.0 vs 6.0, p<.001). There was no difference in total charges. Examination of organ failure rates demonstrated increased respiratory (24.6% vs 22.1%, p<.001, OR 1.15, CI 1.13-1.16), cardiovascular (7.7% vs 7.0%, p<.001, OR 1.11, CI 10.09-1.14), hepatic (3.9% vs 3.0%, p<.001, OR 1.31, CI 1.27-1.35), and hematologic (11.0% vs 9.3%, p<.001, OR 1.21, CI 1.18-1.23) organ failures in non-diabetic admissions. Septic admissions with type II diabetes were found to have higher rates of renal failure (49.4% vs 42.2%, p<.001, OR .75, CI .74-.76). There were no differences in rate of metabolic (16.8% vs 16.9%) or neurologic (2.7% vs 2.8%) organ failures between non-diabetic and diabetic admissions, respectively. CONCLUSIONS: Non-diabetic septic patients have higher mortality rates than diabetic septic patients despite increased age, LOS and number of chronic conditions in diabetics. As expected, septic patients with diabetes demonstrated higher rates of renal failure. CLINICAL IMPLICATIONS: Clinicians must be proactive with sepsis regardless of diabetic status due to high mortality. Understanding organ failure rates can aid in early monitoring and treatment during sepsis admissions. DISCLOSURES: No relevant relationships by Jacob Baer, source=Web Response No relevant relationships by Sai Guda, source=Web Response No relevant relationships by Catherine Mayer, source=Web Response