Table 2.
Baseline characteristics, clinical course and outcome of patients with diabetes mellitus and sepsis, who were stratified according insulin or metformin use prior to ICU admission
| Diabetes mellitus treated with insulin | Diabetes mellitus not treated with insulin | P value | Diabetes mellitus treated with metformin | Diabetes mellitus not treated with metformin | P value | |
|---|---|---|---|---|---|---|
| Patients, n (%) | 133 (55.2 %) | 108 (44.8 %) | 114 (47.3 %) | 127 (52.7 %) | ||
| Demographic data | ||||||
| Age mean (SD), years | 64.3 (12.5) | 68.1 (10.0) | <0.01 | 67.0 (10.4) | 65.1 (12.6) | 0.19 |
| Gender male, n (%) | 71 (53.4 %) | 73 (67.6 %) | 0.04 | 78 (68.4 %) | 66 (52.0 %) | 0.01 |
| Body mass index mean (SD) | 28.9 (8.5) | 28.9 (6.7) | 0.98 | 29.0 (7.7) | 28.8 (7.9) | 0.86 |
| Race, white, n (%) | 115 (86.5 %) | 87 (80.6 %) | 0.45 | 97 (85.1 %) | 105 (82.7 %) | 0.66 |
| Medical admission, n (%) | 104 (78.2 %) | 84 (77.8 %) | >0.99 | 92 (80.7 %) | 96 (75.6 %) | 0.37 |
| Chronic comorbidity, n (%) | ||||||
| Cardiovascular compromise | 49 (36.8 %) | 54 (50.0 %) | 0.05 | 48 (42.1 %) | 55 (43.3 %) | 0.89 |
| COPD | 22 (16.5 %) | 15 (13.9 %) | 0.59 | 16 (14.0 %) | 21 (16.5 %) | 0.59 |
| Hypertension | 66 (49.6 %) | 63 (58.3 %) | 0.20 | 65 (57.0 %) | 64 (50.4 %) | 0.34 |
| Malignancy | 25 (18.8 %) | 36 (33.3 %) | 0.02 | 32 (28.1 %) | 29 (22.8 %) | 0.38 |
| Renal insufficiency | 41 (30.8 %) | 16 (14.8 %) | <0.01 | 10 (8.8 %) | 47 (37.0 %) | <0.001 |
| Modified Charlson Comorbidity Indexa | 4 (3–6) | 5 (4–6) | 0.01 | 5 (3–6) | 5 (3–6) | 0.85 |
| Diabetic medication, n (%) | ||||||
| Insulin | 132 (100.0 %) | - | 44 (38.6 %) | 88 (69.3 %) | <0.001 | |
| Metformin | 44 (33.1 %) | 70 (64.8 %) | <0.001 | 114 (100.0 %) | - | |
| Glimepiride | 5 (3.8 %) | 17 (15.7 %) | <0.01 | 18 (15.8 %) | 4 (3.1 %) | <0.001 |
| Glibenclamide | - | 1 (0.9 %) | 0.47 | 1 (0.9 %) | - | |
| Gliclazide | 2 (1.5 %) | 3 (2.8 %) | 0.66 | 2 (1.8 %) | 3 (2.4 %) | >0.99 |
| Tolbutamide | 3 (2.3 %) | 21 (19.4 %) | <0.001 | 8 (7.0 %) | 16 (12.6 %) | 0,18 |
| Any oral anti-diabetic medication | 48 (36.1 %) | 89 (82.4 %) | <0.001 | 114 (100.0 %) | 23 (18.1 %) | <0.0001 |
| Severity of disease on ICU admission | ||||||
| APACHE IV score, median (IQR) | 82 (67–106) | 83 (65–103) | 0.97 | 83 (64–106) | 82 (68–104) | 0.62 |
| APACHE APS, median (IQR) | 68 (52–87) | 65 (51–85) | 0.54 | 66 (50–90) | 68 (54–86) | 0.56 |
| SOFA score, median (IQR) | 7 (6–9) | 7 (5–9) | 0.58 | 7 (5–8) | 8 (6–10) | 0.05 |
| Mechanical ventilation, n (%) | 79 (59.4 %) | 76 (70.4 %) | 0.07 | 70 (61.4 %) | 85 (66.9 %) | 0.41 |
| Organ failure, n (%) | 115 (86.5 %) | 87 (80.6 %) | 0.56 | 94 (82.5 %) | 108 (85.0 %) | 0.77 |
| Shock, n (%) | 46 (34.6 %) | 32 (29.6 %) | 0.50 | 28 (24.6 %) | 50 (39.4 %) | 0.02 |
| Acute kidney injury, n (%) | 56 (42.1 %) | 40 (37.0 %) | 0.43 | 50 (43.9 %) | 46 (36.2 %) | 0.22 |
| Acute lung injury, n (%) | 31 (23.3 %) | 30 (27.8 %) | 0.46 | 30 (26.3 %) | 31 (24.4 %) | 0.79 |
| Acute myocardial infarction, n (%) | 4 (3.0 %) | 3 (2.8 %) | >0.99 | 5 (4.4 %) | 2 (1.6 %) | 0.25 |
| Laboratory measurements first 24 hours after ICU admission (peak values), median (IQR) | ||||||
| Glucose (mmol/L) | 12.8 (10.8–16.6) | 12.9 (10.0–15.5) | 0.17 | 12.5 (10.3–15.5) | 13.3 (10.6–16.7) | 0.43 |
| Lactate (mmol/mL) | 3.2 (2-4.9) | 2.9 (1.6–4.5) | 0.35 | 2.7 (1.6–4.5) | 3.3 (2–5.1) | 0.22 |
| Creatinin (μmol/L) | 146 (89–228) | 123 (92–173) | 0.08 | 124 (87–170) | 151 (95–255) | 0.01 |
| Outcome | ||||||
| Length of ICU stay (days), median (IQR) | 4 (2-9) | 4 (2-9) | >.99 | 5 (2-10) | 4 (2-9) | 0.65 |
| Hospital length of stay (days), median (IQR) | 21 (11–44) | 21 (9–38) | 0.55 | 22 (11–44) | 20 (10–40) | 0.44 |
| Complications, n (%) | ||||||
| None | 108 (81.2 %) | 91 (84.3 %) | 0.60 | 96 (84.2 %) | 103 (81.1 %) | 0.62 |
| Acute kidney injury | 13 (9.8 %) | 12 (11.1 %) | 0.82 | 11 (9.6 %) | 14 (11.0 %) | 0.84 |
| Acute lung injury | 7 (5.3 %) | 3 (2.8 %) | 0.35 | 4 (3.5 %) | 6 (4.7 %) | 0.76 |
| ICU-acquired weakness | 6 (4.5 %) | 7 (6.5 %) | 0.56 | 6 (5.3 %) | 7 (5.5 %) | >0.99 |
| Acute myocardial infarction | 1 (0.8 %) | 1 (0.9 %) | >0.99 | 2 (1.8 %) | - | 0.22 |
| ICU-acquired infection | 16 (12.0 %) | 6 (5.6 %) | 0.13 | 8 (7.0 %) | 14 (11.0 %) | 0.39 |
| Mortality, n (%) | ||||||
| ICU | 23 (17.3 %) | 24 (22.2 %) | 0.42 | 18 (15.8 %) | 29 (22.8 %) | 0.20 |
| Hospital | 43 (32.3 %) | 35 (32.4 %) | >0.99 | 32 (28.1 %) | 46 (36.2 %) | 0.22 |
| Day 30 | 41 (30.8 %) | 31 (28.7 %) | 0.77 | 31 (27.2 %) | 41 (32.3 %) | 0.47 |
| Day 60 | 50 (37.6 %) | 40 (37.0 %) | >0.99 | 38 (33.3 %) | 52 (40.9 %) | 0.25 |
| Day 90 | 51 (38.3 %) | 44 (40.7 %) | 0.79 | 41 (36.0 %) | 54 (42.5 %) | 0.30 |
aModified Charlson Index was calculated without the contribution of diabetes mellitus. APACHE Acute Physiology and Chronic Health Evaluation, APS Acute Physiology Score, COPD chronic obstructive pulmonary disease, ICU intensive care unit