Preexisting Diabetes Mellitus and All-Cause Mortality in Adult Patients With Sepsis: A Population-Based Cohort Study

• Published in: Critical care explorations Vol. 6; no. 5; p. e1085
• Main Authors: Angriman, Federico, Saoraya, Jutamas, Lawler, Patrick R, Shah, Baiju R, Martin, Claudio M, Scales, Damon C
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-05-2024; Wolters Kluwer
• Subjects: Adult; Aged; Aged, 80 and over; Cohort Studies; Diabetes Mellitus - epidemiology; Diabetes Mellitus - mortality; Female; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Observational Study; Ontario - epidemiology; Renal Replacement Therapy; Respiration, Artificial; Risk Factors; Sepsis - mortality; Sepsis - therapy; Ontario
• ISSN: 2639-8028; 2639-8028
• DOI: 10.1097/CCE.0000000000001085

We assessed the association of preexisting diabetes mellitus with all-cause mortality and organ support receipt in adult patients with sepsis.
Population-based cohort study.
Ontario, Canada (2008-2019).
Adult patients (18 yr old or older) with a first sepsis-related hospitalization episode.
None.
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.
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.