Correlation between blood glucose level on admission and prognosis in patients with sepsis

Objective To explore the correlation between blood glucose level on admission and prognosis in patients with sepsis.

Methods A total of 290 hospitalized patients with sepsis in the Emergency Department of Affiliated Hospital of Nantong University from April 2016 to October 2021 were selected, and they were divided into normal blood glucose group (blood glucose level ranged from 4.0 to 7.7 mmol/L) with 116 cases, mild hyperglycemia group (blood glucose level ranged from greater than 7.7 to 11.0 mmol/L) with 95 cases, and severe hyperglycemia group (blood glucose level was greater than 11.0 mmol/L) with 79 cases according to the blood glucose level on admission, and hypoglycemia group was excluded. Restricted cubic spline curve was used to analyze the relationship between blood glucose level and 28-day mortality; the Logistic regression model was used to analyze the correlation between blood glucose grade and 28-day mortality; subgroup analysis was performed based on the presence or absence of previous hypertension and diabetes.

Results Of the 290 patients, 70 cases (24.1%) died within 28 days. Compared with the survival group (n=220), the age, the Sequential Organ Failure Score (SOFA) and the Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ) score of patients in the death group were significantly higher (P < 0.05). In the comparison of baseline characteristic materials between normal blood glucose group, mild hyperglycemia group and severe hyperglycemia group, the results showed that with the aggravation of hyperglycemia severity, the previous prevalence rates of hypertension and diabetes were significantly higher (P=0.01, P < 0.01), while the prothrombin time (PT) and activated partial thrombin time (APTT) significantly shortened (P < 0.01); the 28-day mortalities of the three groups were 18.1%, 22.1% and 35.4% respectively, and there was significant difference among three groups (P=0.02). With the increase of blood glucose level, the risk of 28-day mortality increased in a linear relationship (non-linear test P=0.856); the univariate Logistic regression analysis showed that increases of age, SOFA score and APACHE Ⅱ score as well as increased degree of blood glucose level were correlated with 28-day mortality (P < 0.05); in both model 1 and model 2 established by multivariate regression analysis, severe hyperglycemia was independently associated with 28-day mortality (OR=2.48, 3.38; 95%CI, 1.25 to 4.95, 1.50 to 7.63); the subgroup analysis for the presence or absence of previous hypertension and diabetes showed no significant interaction (P>0.05).

Conclusion Severe hyperglycemia on hospital admission in patients with sepsis is associated with increased risk of 28-day mortality, which should be considered seriously by clinicians.