A Study On The Effect Of Hypoglycemia On In-hospital Mortality In Patients With Sepsis

Objective:The study aimed to investigate the effect of hypoglycemia on the mortality of hospitalized patients with sepsis and analyze the risk factors associated with hypoglycemia.Methods:We retrospectively analyzed the clinical data of septic patients meeting the criteria for inclusion in the Department of Critical Care in the First Hospital of Qinhuangdao from June 2017 to March 2018.According to the survival conditions during hospitalization,the patients were divided into survival group and death group.The differences in APACHE II,SOFA,incidence of hypoglycemia and standard deviation of blood glucose were compared between groups.Binary Logistic regression analysis was used to find independent risk factors that affected the prognosis of the disease.Patients were divided into hypoglycemic and non-hypoglycemic groups and we analyzed risk factors of hypoglycemia in septic patients.Results:1.A total of 90 patients with sepsis were included,including 52 cases(57.8%)of septic shock,with an average age of(66.8±11.7)years,APACHE II [18.0(13.8,25.3)],and SOFA [6.5(4.0,8.3)].There were 47 males(52.2%)and 43 females(47.8%).The survival group was 63(70%)and the death group was 27(30%).There were 57 cases(63.3%)with intra-abdominal infection,20 cases(22.2%)with pulmonary infection,11 cases(12.2%)with urinary tract infection and 2 cases(2.2%)with skin and soft tissue infection.Among the subjects,27 cases(30%)were diabetes mellitus,31 cases(34.4%)were hypertension,16 cases(17.8%)were coronary heart disease,7 cases(7.8%)were cardiac insufficiency,7 cases(7.8%)were chronic renal insufficiency,10 cases(11.1%)were tumor and 12 cases(13.3%)were cerebrovascular disease.Mechanical ventilation was performed in 66 cases(73.3%),13 cases(14.44%)with CRRT.There were 27 cases(30%)that controlled blood glucose with insulin,including 18 cases(66.7%)of diabetes.A total of 5411 blood glucose values were collected,with a maximum blood glucose value of 33.3 mmol/L and a minimum blood glucose value of 0.9 mmol/L.62 patients had hyperglycemia(68.9%),27 patients had hypoglycemia(30%),and 5 patients had severe hypoglycemia(5.6%).26 patients did not use insulin to control blood glucose on the day of hypoglycemia.1 patient with hypoglycemia had stopped insulin therapy 3 hours before.19 patients with hypoglycemia did not use insulin to control blood glucose during ICU admission.5 patients merged with hypoglycemia at the time of initial admission to the ICU.Hypoglycemic events could occur at all periods with the highest frequency of hypoglycemia occurring at 7:00-10:00 which could reach 2.3%.The frequency of hypoglycemia occurring at 12:00-15:00 was 1.6%.The frequency of hypoglycemia was 1.3% from 10:00 to 12:00.The frequency of hypoglycemia from 5:00 to 7:00 was 1.2%.The frequency of hypoglycemia was 1.1% at 0:00-5:00.The frequency of hypoglycemia at other times was less than 1%.2.The APACHE II,SOFA,incidence of hypoglycemia,incidence of severe hypoglycemia,standard deviation of blood glucose,lactate,ratio of mechanical ventilation,proportion of CRRT,proportion of diabetes,and ratio of insulin-controlled blood glucose in death group were significantly higher than those in survival group(P <0.05).Binary Logistic regression analysis suggested that hypoglycemia is one of the independent risk factors affecting the prognosis of patients with sepsis(OR=5.286,95%CI=1.558~17.929,P=0.008).3.The APACHE II,SOFA,lactate,proportions of septic shock and CRRT in the hypoglycemia group were significantly higher than those in the non-hypoglycemic group(P <0.05).There was no significant difference in the proportion of patients with hypoglycemic and non-hypoglycemic groups who used insulin to control blood glucose(P>0.05).Binary Logistic regression analysis showed that APACHE II and CRRT were independent risk factors for hypoglycemia in septic patients.Conclusion:1.Hypoglycemia is one of the independent risk factors affecting the prognosis of patients with sepsis.2.The occurrence of hypoglycemia is related to the severity of the disease and the risk of hypoglycemia is increased in patients undergoing CRRT.