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 identified 12.5 million cases of sepsis, and 17% of the patients had diabetes. Among those with diabetes and sepsis, 57% were women and 64% were white. The average age was 68 years.
Overall, patients with diabetes and sepsis were significantly more likely to develop acute renal failure than were patients without diabetes (13% vs. 7%), but were significantly less likely (9% vs. 14%) to develop acute respiratory failure (Crit. Care 2009 Feb. 12 [doi:10.1186/cc7717]).
The difference in acute respiratory failure persisted regardless of the infection source. 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.
Although the overall fatality rate for sepsis patients with diabetes was significantly lower than for those without diabetes (19% vs. 21%), the fatality rates between patients with and without diabetes who developed acute respiratory failure were not significantly different (52% vs. 48%).
Theories as to why respiratory failure rates differ between patients with and without diabetes include blunted inflammatory response to organ dysfunction in people with diabetes, and the possibility that diabetes patients may be hospitalized for sepsis sooner because they are more alert to signs of infection. Diabetes medications may play a role, too. “Many medications administered to patients with [diabetes], including insulin and thiazolidinediones, are known to have anti-inflammatory effects in addition to lowering blood glucose,” they noted.
The researchers had no financial conflicts to disclose.