Cancer history, bandemia, and serum creatinine are independent mortality predictors in patients with infection-precipitated hyperglycemic crises

BMC Endocrine Disorders

How-Ran Guo⁶  Hsien-Yi Wang⁵  Jiann-Hwa Chen¹  Wei-Lung Chen¹  Shu-Chun Kuo³  Shih-Chung Chen⁴  Hung-Jung Lin⁷  Willy Chou²  Chien-Cheng Huang⁶ 

[1] Fu Jen Catholic University School of Medicine, Taipei, Taiwan;Department of Recreation and Health Care Management, Cha Nan University of Pharmacy and Science, Tainan, Taiwan;Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan;Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan;Department of Sport Management, College of Leisure and Recreation Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan;Department of Environmental and Occupational Health, Medical College, National Cheng Kung University, Tainan, Taiwan;Department of Biotechnology, Southern Taiwan University, Tainan, Taiwan

关键词: Predictor;    Mortality;    Infection;    Hyperosmolality;    Hyperglycemic crises;   

Others  :  1085814
DOI  :  10.1186/1472-6823-13-23

 received in 2013-01-13, accepted in 2013-06-11,  发布年份 2013

【 摘 要 】

Background

Infection is the most common precipitating factor and cause of death in patients with hyperglycemic crises. Treating infection-precipitated hyperglycemic crises includes using empiric antibiotics early; correcting dehydration, hyperglycemia, and electrolyte imbalances; and frequent monitoring. Intensive care unit admission, broad-spectrum antibiotics, and even novel therapy for infection may be beneficial for patients with a high risk of mortality. However, these management options are costly and not beneficial for every patient. Selecting high-risk patients who would most likely benefit is more appropriate. We investigated the independent mortality predictors of patients with infection-precipitated hyperglycemic crises to facilitate clinical decision making.

Methods

This study was conducted in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the Emergency Department between January 2004 and December 2010 were enrolled when they met the criteria of an infection-precipitated hyperglycemic crisis. Thirty-day mortality was the primary endpoint.

Results

One hundred forty-two patients were enrolled. The infection source did not predict mortality. The presenting variables that were independently associated with 30-day mortality in a multiple logistic regression model were cancer history (odds ratio [OR], 7.4; 95% confidence interval [CI], 2.4-23.2), bandemia (OR, 7.0; 95% CI, 1.6-30.3), and serum creatinine (OR, 1.4; 95% CI, 1.1-1.8). The common sources of infection were the lower respiratory tract (30.3%), urinary tract (49.3%), skin or soft tissue (12.0%), and intra-abdominal (6.3%).

Conclusions

Cancer history, bandemia, and serum creatinine level are three independent mortality predictors for patients with infection-precipitated hyperglycemic crises. These predictors are both readily available and valuable for physicians making decisions about risk stratification, treatment, and disposition.

【 授权许可】

   
2013 Huang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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