NICE, FRANCE — A new study suggests that stress hyperglycemia may be an important predictor of morbidity and mortality in nondiabetic patients with sepsis.
The investigation included 242 patients without diabetes who were hospitalized with severe sepsis in three hospitals in southwestern Greece during a 1-year period.
Hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dL or more, or a random blood glucose level of 200 mg/dL or more on two or more evaluations.
Stress hyperglycemia—defined as a transient elevation of blood glucose levels due to various factors including stress, injury, and surgery—was present in 20% of the participating patients, Dr. Lydia Leonidou reported at the 16th European Congress on Clinical Microbiology and Infectious Diseases.
Moreover, a significantly higher percentage of septic patients with stress hyperglycemia died, compared with those participants who had normal glucose levels (43.4% vs. 13.2%), the investigator reported.
Stress hyperglycemia was not related to a genetic predisposition to diabetes mellitus. Only 6% of hyperglycemic patients had a first-degree relative with diabetes, compared with 11% of normal glycemic patients, reported Dr. Leonidou and her colleagues at the University of Patras (Greece).
Sources of infection in all patients were: respiratory tract 42%, urinary tract 35%, intraabdominal 16%, central nervous system 3%, soft tissue 3%, and endocarditis 1%.
Hyperglycemic patients were older than normal glycemic patients, but the difference was not statistically significant (73.4 years vs. 65.7).
There was no significant difference in gender, body mass index, C-reactive protein, blood cultures, and hospitalization days between groups.
Hemoglobin A1c levels were significantly higher among hyperglycemia patients (5.73% vs. 5.44%) but were within the normal range of 4%–5.9%.
The investigators also found that patients with stress hyperglycemia had a significantly higher sepsis-related organ failure assessment (SOFA) score than patients with normal glycemia (mean 4.9 vs. 2.9).
This finding led some of the people who were attending the meeting to question whether stress hyperglycemia caused poor outcomes or was just another surrogate marker such as the SOFA score itself.
The study's lead author Dr. Charalambos Gogos responded, “We believe that hyperglycemia is not [just] a surrogate marker, but something you have to fight in your patients with good glycemic control.”