成人败血症患者原有糖尿病与全因死亡率:一项基于人群的队列研究。

Q4 Medicine Critical care explorations Pub Date : 2024-05-06 eCollection Date: 2024-05-01 DOI:10.1097/CCE.0000000000001085
Federico Angriman, Jutamas Saoraya, Patrick R Lawler, Baiju R Shah, Claudio M Martin, Damon C Scales
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引用次数: 0

摘要

目的我们评估了脓毒症成人患者中既往糖尿病与全因死亡率和接受器官支持的关系:设计:基于人群的队列研究:地点:加拿大安大略省(2008-2019年):干预措施:无:干预措施:无:主要研究对象是既往患有糖尿病(1型或2型)的患者。主要结果是90天内的全因死亡率;次要结果包括接受有创机械通气和新的肾脏替代治疗。我们报告了调整后的风险比 (RRs) 和 95% CI。一项主要的二次分析评估了既往糖尿病与脓毒症后全因死亡率之间的关系是否可能受到二甲双胍的影响。研究共纳入了503455名首次接受败血症相关住院治疗的成年人,其中36%的人患有糖尿病。平均年龄为73岁,54%为女性。既往糖尿病与90天内全因死亡的调整后风险降低有关(RR,0.81;95% CI,0.80-0.82)。原有糖尿病与新的肾脏替代治疗风险增加有关(RR,1.53;95% CI,1.46-1.60),但与侵入性机械通气无关(RR,1.03;95% CI,1.00-1.05)。总体而言,21%(95% CI,19-28)的既往糖尿病与全因死亡风险降低之间的关系是由既往使用二甲双胍介导的:结论:既往糖尿病与脓毒症成人患者较低的全因死亡风险和较高的新肾脏替代治疗风险有关。未来的研究应评估这些关联的潜在机制。
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Preexisting Diabetes Mellitus and All-Cause Mortality in Adult Patients With Sepsis: A Population-Based Cohort Study.

Objectives: We assessed the association of preexisting diabetes mellitus with all-cause mortality and organ support receipt in adult patients with sepsis.

Design: Population-based cohort study.

Setting: Ontario, Canada (2008-2019).

Population: Adult patients (18 yr old or older) with a first sepsis-related hospitalization episode.

Interventions: None.

Measurements and main results: The main exposure of interest was preexisting diabetes (either type 1 or 2). The primary outcome was all-cause mortality by 90 days; secondary outcomes included receipt of invasive mechanical ventilation and new renal replacement therapy. We report adjusted (for baseline characteristics using standardization) risk ratios (RRs) alongside 95% CIs. A main secondary analysis evaluated the potential mediation by prior metformin use of the association between preexisting diabetes and all-cause mortality following sepsis. Overall, 503,455 adults with a first sepsis-related hospitalization episode were included; 36% had preexisting diabetes. Mean age was 73 years, and 54% of the cohort were females. Preexisting diabetes was associated with a lower adjusted risk of all-cause mortality at 90 days (RR, 0.81; 95% CI, 0.80-0.82). Preexisting diabetes was associated with an increased risk of new renal replacement therapy (RR, 1.53; 95% CI, 1.46-1.60) but not invasive mechanical ventilation (RR, 1.03; 95% CI, 1.00-1.05). Overall, 21% (95% CI, 19-28) of the association between preexisting diabetes and reduced risk of all-cause mortality was mediated by prior metformin use.

Conclusions: Preexisting diabetes is associated with a lower risk of all-cause mortality and higher risk of new renal replacement therapy among adult patients with sepsis. Future studies should evaluate the underlying mechanisms of these associations.

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