Association between Controlled and Uncontrolled DM and Prognosis of Critically ill Patients with Sepsis
Authors: Abouelftouh Ahmed Hosny , Nabil El-Shafaey Mohammed Mohammed , Hassan Kashef Neven Ahmed , Moussa Aya Hisham 
Published: July 2024

Abstract

Background
In patients with sepsis, an inflammatory response can lead to destruction of the glycocalyx. These alterations cause the progression of organ dysfunction. Destruction of the glycocalyx can also occur in chronic hyperglycemia. Glycated hemoglobin (HbA1c) is a reliable marker of premorbid hyperglycemia.

Aim of Work
to investigate the association between HbA1c level including the difference between controlled and uncontrolled diabetes mellitus at admission and the degree of organ dysfunction progression 5 days after admission and ICU mortality.

Patients and Methods
This is a retrospective observational study that included 50 critically ill diabetic patients suffering from sepsis, conducted at the Intensive Care Department, Ain Shams University Hospital. The study design was approved by Ain Shams Faculty of Medicine’s Ethical Committee. All fifty patients were categorized as being diabetic suffering from sepsis into two groups: Group (A): included 25 patients with HBA1C 7% or below. Group (B): included 25 with HBA1C above 7%.

Results
HbA1C, procalcitonin, ALT, AST and lactic acid were significantly higher in group B compared to group A (P values &lt;0.05) while PLT count was significantly higher in group A compared to group B (P value&lt;0.001). Glucose, CRP and ALT were insignificantly different between the studied groups. Regarding urine analysis, number of patients who had acetone in urine was significantly higher in group B (with HbA1C &gt; 7%) compared to group A (with HbA1C ≤ 7), therefore all those patients were diagnosed as DKA patients and needed insulin. Norepinephrine and Terlipressin use was significantly higher in group B compared to group A (P value = 0.022, 0.007) while epinephrine, dobutamine and dopamine use was insignificantly different between the two groups. Hemodialysis was significantly higher in patients with higher HbA1C level &gt; 7% compared to those with lower HbA1C level (P value = 0.016), while ventilator use was comparable between the two groups. Within 5 days of ICU admission, the incidence of organ dysfunction was significantly higher in patients with higher HbA1C &gt;7% compared to those with lower level of HbA1C (P value = 0.041). Mortality was significantly higher within significantly shorter time in patients with higher HbA1C &gt;7% compared to those with lower level of HbA1C (P value = 0.002, 0.04 respectively). HbA1C can significantly predict the severity of organ dysfunction with AUC of 0.749 (P value &lt;0.001), at cut off &gt;6.9%, HbA1C is a significant predictor for organ dysfunction severity with sensitivity of 94.74%, specificity of 54.84%, PPV of 56.2% and NPV of 94.4%.

Conclusion
The most common causes of sepsis in ICU patient were pulmonary sepsis followed by urinary tract sepsis. Norepinephrine and terlipressin use was significantly higher in uncontrolled diabetes. Most of patients with uncontrolled diabetes were on hemodialysis while the ventilation use was comparable between the studied groups. Patients with non-controlled diabetes had higher incidence of organ dysfunction and mortality. Age, HbA1C, procalcitonin, PLT and lactic acid were significant predictors for the severity of organ dysfunction within 5 days of ICU admission. We concluded that HbA1C could predict the severity of organ dysfunction.