Admission hyperglycemia in critically ill sepsis patients: Association with outcome and host response
Open accessAbstract
Objectives: To investigate whether admission hyperglycemia is associated with the presentation and/or outcome of sepsis, what the influence of hyperglycemia is on key host responses to sepsis, and whether hyperglycemia differentially affects patients with diabetes mellitus. Design and Setting: A substudy of a prospective observational cohort study was conducted in the intensive care of two tertiary hospitals between January 2011 and July 2013. Patients: Of all consecutive critically ill sepsis patients, admission glucose was used to stratify patients in euglycemia (71–140 mg/dL), mild hyperglycemia (141–199 mg/dL), and severe hyperglycemia (≥ 200 mg/dL), and patients with hypoglycemia were excluded. Fifteen plasma biomarkers providing insight in key host responses implicated in sepsis pathogenesis were measured on admission. Measurements and Main Results: Of 987 sepsis patients with admission glucose levels greater than 70 mg/dL, 519 (52.6%) had normal glucose levels, 267 (27.1%) had mild, and 201 (20.4%) severe hyperglycemia. Admission hyperglycemia was accompanied by mitigated alterations in plasma host response biomarker levels indicative of activation of the cytokine network, the vascular endothelium, and the coagulation system in patients without a history of diabetes. Severe, but not mild, admission hyperglycemia was associated with increased 30-day mortality (adjusted hazard ratio, 1.66 [95% CI, 1.24–2.23]), in both patients without diabetes (adjusted hazard ratio, 1.65 [95% CI, 1.12–2.42]) and with diabetes (adjusted hazard ratio, 1.91 [95% CI, 1.01–3.62]). Conclusion: Admission hyperglycemia is associated with adverse outcome of sepsis irrespective of the presence or absence of preexisting diabetes by a mechanism unrelated to exaggerated inflammation or coagulation.
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Inpatient hyperglycemia is associated with more complications, including surgical site infections, mortality, and longer hospital stays.
“Inpatient hyperglycemia is associated with increased complications including surgical site infections, mortality, and increased length of hospital stay.91–93”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [91]
In Sepsis Course and Outcome (page not provided), severe admission hyperglycemia in ICU patients with sepsis was associated with higher 30-day mortality and, among patients without diabetes, more acute kidney injury and myocardial infarction. The paper does not report an association with surgical site infections or longer hospital stays; it says ICU lengths of stay were similar between glucose groups. Its findings also concern severe hyperglycemia at admission, not inpatient hyperglycemia generally. (LLM, conf=0.90)
Experimental — accuracy not yet measuredPeople without preexisting diabetes or stress hyperglycemia have a higher incidence of more complications after heart surgery.
“Those without preexisting DM or stress hyperglycemia have a higher incidence of more postheart surgery complications.91,100–103”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [91]
The Sepsis Course and Outcome section (page unavailable) reports more acute kidney injury and acute myocardial infarction among patients without known diabetes who had severe admission hyperglycemia. It does not study complications after heart surgery, and its finding concerns patients with hyperglycemia—not patients without it, as the citing sentence says. (LLM, conf=0.82)
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- Authors
- van Vught, L. A., Wiewel, M. A., Klein Klouwenberg, P. M. C., Hoogendijk, A. J., Scicluna, B. P., Ong, D. S. Y., Cremer, O. L., Horn, J., Bonten, M. M. J., Schultz, M. J., & van der Poll, T.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- University Medical Center Utrecht (NL)
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.
- ORCID
- Venue
- Critical Care Medicine
- Published
- 2016-07
- Volume
- 44
- Issue
- 7
- Pages
- 1338-1346
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2295634666
- Cited by
- 130
- References
- 49
- Citations by year
- 2026: 6 · 2025: 18 · 2024: 10 · 2023: 16 · 2022: 8 · 2021: 16 · 2020: 14 · 2019: 17 · 2018: 9 · 2017: 7 · 2016: 9
- FWCI
- 14.05
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- Center for Translational Molecular Medicine (04I-201)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- sepsis, admission hyperglycemia, critically ill patients, host response biomarkers, diabetes mellitus, 30-day mortality, cytokine network, vascular endothelium, coagulation, plasma biomarkers, intensive care
- MeSH terms
- Aged, Female, Hospitalization, Hospitals, Teaching, Humans, Hyperglycemia, Intensive Care Units, Male, Middle Aged, Prospective Studies, Critical Illness, Sepsis, Diabetes Complications
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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