Impact of Diabetes Mellitus on Outcomes of Patients with Sepsis: An Updated Systematic Review and Meta-analysis

Abstract

Background

• Unclear impact of diabetes on sepsis outcomes.
• 2017 meta-analysis: diabetes does not increase sepsis mortality, but raises risk of acute renal injury.
• Need for updated evidence due to new studies.

Methods

• Systematic search in PubMed, Scopus, Embase, Google Scholar.
• Included observational studies in sepsis patients.
• Statistical analysis with STATA.

Results

• 21 studies included.
• No significant difference in mortality between diabetics and non-diabetics.
• High blood glucose at admission increases in-hospital mortality.
• Diabetics have higher risk of acute renal failure.
• Similar risk for respiratory failure, cardiac events, hospitalization post-discharge, and length of stay.

Conclusions

• Diabetes not tied to poor sepsis survival outcomes but increases acute renal failure risk.
• High blood glucose linked to higher in-hospital mortality.
• Importance of renal function evaluation in diabetic-sepsis patients.

Introduction

• Sepsis: life-threatening organ dysfunction from infection response.
• Significant hospital mortality.
• Diabetes prevalent in 20% of septic patients.
• Rising diabetes incidence globally.
• Diabetes predisposes to infection, affects immune response.
• 2017 meta-analysis: diabetes increases renal injury risk but not sepsis mortality.

Materials and Methods

Search Strategy

• Conducted following PRISMA guidelines.
• Searched English publications in PubMed, Scopus, Embase, Google Scholar.
• Registered in PROSPERO.

Selection Criteria

• Included observational studies with data on sepsis outcomes based on diabetes status.
• Excluded case reports, reviews.

Data Extraction and Quality Assessment

• Used Newcastle-Ottawa Scale for quality assessment.

Statistical Analysis

• Pooled relative risk (RR) and weighted mean difference (WMD) calculated.
• Subgroup analysis for sepsis stages.
• Analyzed impact of blood glucose levels on outcomes.

Results

Study Selection and Characteristics

• 4108 citations screened, 21 studies included.
• Studies from multiple countries, quality assessed as good.

Diabetes Status and Mortality

• No significant difference in in-hospital or 90-day mortality between diabetics and non-diabetics.
• High blood glucose at admission increases in-hospital mortality.

Complication Risks

• Diabetics at higher risk for acute renal failure.
• Similar risks for respiratory failure and cardiac events.

Other Outcomes

• Length of stay, re-hospitalization need similar between groups.

Discussion

• Diabetes impairs immune response, increases susceptibility to infections.
• Findings align with 2017 meta-analysis.
• High blood glucose linked to in-hospital mortality, not long-term.
• Need for further research on blood glucose and sepsis outcomes.

Conclusion

• Diabetes not linked to poor sepsis survival but increases acute renal failure risk.
• High blood glucose increases in-hospital mortality.
• More research needed for conclusive evidence.

Availability of Data and Materials

• Data available on request from corresponding author.

Authors

• Li Jiang, Mengdi Cheng
• No competing interests declared.

Funding and Ethics

• No funding.
• Ethics approval not applicable.

Supplementary Information

• Additional file: Search strategy, study quality assessment.