Impact of diabetes on mortality among patients with community-acquired bacteremia
Introduction
Bacteremia is a potentially life-threatening disease with a high case-fatality rate of 30–40%.1 Diabetic patients may have decreased immunity including depressed polymorphonuclear leukocyte function, and impaired phagocytosis and chemotaxis2, 3 and are thought to be at increased risk for infections and bacteremia.4, 5, 6 However, data are sparse regarding the effect of diabetes on mortality once diabetic patients have become bacteremic. In addition, limited data from previous studies on the association between diabetes and mortality are conflicting in the setting of bacteremia.7, 8, 9, 10 These studies either included nosocomial bacteremia in hospitalized patients,7, 8 or focused on specific bacteremia pathogens.9, 10 Therefore the results may not be generalizable to patients with community-acquired bacteremia. In this frequently encountered patient population, it remains unknown whether diabetes influences mortality.
Based on the findings of impaired cellular immunity among diabetic patients, we hypothesized that diabetes may adversely affect mortality among patients with community-acquired bacteremia. We conducted a hospital-based prospective observational study among bacteremic patients admitted from the emergency department (ED). The objective of this study was to assess the independent effect of diabetes on short-term (30-day) mortality among these bacteremic patients.
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Study population
From June 1, 2001 through May 31, 2002, we conducted a hospital-based observational study initiated from the ED of National Taiwan University Hospital in Taipei, Taiwan. This ED serves an urban, university-based medical center with 2100 beds and approximately 100,000 visits annually. Details of the study design and data collection have been published previously.11 The institutional review board approved the study, and the requirement for informed consent was waived. All patients were managed at
Results
During the 1-year study period, a total of 1346 positive blood cultures were obtained in the ED. According to our inclusion and exclusion criteria, 839 patients were included in current analysis. The detailed selection process is illustrated in Fig. 1. The median age of these patients was 67 years (IQR: 53–77) and 48% were women. The overall prevalence of diabetes was 29% in our study population. The majority of the diabetic patients had type 2 diabetes (98%), with a median history of diabetes
Discussion
In the study, we found no evidence to support our hypothesis that diabetes increases the risk of mortality among patients with community-acquired bacteremia. Our data suggest that once diabetic patients have acquired community-acquired bacteremia, diabetes appears not to have significant impact on 30-day mortality.
Our findings are consistent with, and extend, those from prior reports that diabetes does not influence mortality in the setting of bacteremia.7, 8, 10 In a previous study including
Conclusions
In summary, this study provides evidence that diabetes appears not to have significant impact on 30-day mortality once diabetic patients have acquired community-acquired bacteremia. Several patient factors and markers of disease severity at ED presentation better predicts the risk of 30-day mortality than diabetes. However, this finding should be interpreted in the context that diabetes patients may have the increased incidence of bacteremia, and they may still have an overall increased risk of
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2021, Journal of Diabetes and its ComplicationsCitation Excerpt :On the other hand, in line with our results, both prospective and retrospective studies have previously reported protective or no effect of diabetes on outcomes (Table 2). Diabetic patients presented similar in hospital mortality with non-diabetics presenting with bacteremia,25–29 respiratory tract infection30,31 or critically ill patients presenting in emergency departments10,24,32,33 or within the ICU.11,22,34,35 This is in accordance with studies reporting that DM was not associated with altered host responses during sepsis in critically ill patients in need of ICU,36 suggesting that diabetes mellitus-related low-grade chronic inflammation, activation of the vascular endothelium and the coagulation system37–39 does not influence acute infection-induced alterations in these pathways.
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2012, Journal of Critical CareCitation Excerpt :Thus, a WIC greater than 2 in diabetic patients has been found to be associated with an increased risk of 30-day mortality in community-acquired pneumococcal bacteremia [35]. In addition, in a mixed population with community-acquired bacteremia, a WIC value above 2 significantly increased the risk of 30-day mortality [34]. In line with this observations, our ROC analysis indicated 2 as cutoff value of WIC and a moderate yet significant increase in the risk of death in patients with WIC greater than 2, as revealed by the OR.
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