Background: We undertook a systematic review and meta-analysis to investigate the relationship between blood glucose levels and mortality in patients with sepsis.
Methods: Medline and EMBASE were searched from inception to April 8, 2018. Cohort studies or case-control studies reported the association between blood glucose and mortality in patients with sepsis were selected. Study characteristics, baseline characteristics, definition of hyperglycemia, and outcomes of interest were extracted. We performed a dose-response meta-analysis to assess the effect of blood glucose level on mortality. We also conducted meta-analysis for patients with or without diabetes separately.
Results: Ten cohort studies involving 26 429 patients were included, of which 5 were prospective studies and 5 retrospective studies. Dose-response analysis showed that the effect of blood glucose on mortality may differ in patients with versus without diabetes. There was a U-shaped relationship for patients with diabetes and a J-shaped relationship for patients without diabetes, with blood glucose at 145 to 155 mg/dL corresponding to lowest mortality both in patients with and without diabetes.
Conclusions: Current evidence suggested U-shaped relationship between blood glucose and mortality in all patients irrespective of their diabetes status. Diabetic patients with blood glucose below 145 mg/dL may have poorer prognosis compared to patients without established diabetes.
Keywords: blood glucose; dose–response relationship; mortality; sepsis.
Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia.Cochrane Database Syst Rev. 2018 Oct 29;10(10):CD012661. doi: 10.1002/14651858.CD012661.pub2. Cochrane Database Syst Rev. 2018. PMID: 30371961 Free PMC article.
Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Systematic Review for the U.S. Preventive Services Task Force [Internet].Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Jul. Report No.: 15-05222-EF-1. Agency for Healthcare Research and Quality (US). 2017. PMID: 29364620 Free Books & Documents. Review.
Diabetes is not associated with increased mortality in emergency department patients with sepsis.Ann Emerg Med. 2011 Nov;58(5):438-44. doi: 10.1016/j.annemergmed.2011.03.052. Epub 2011 Jun 16. Ann Emerg Med. 2011. PMID: 21683473 Free PMC article. Clinical Trial.
The HbA1c and all-cause mortality relationship in patients with type 2 diabetes is J-shaped: a meta-analysis of observational studies.Rev Diabet Stud. 2014 Summer;11(2):138-52. doi: 10.1900/RDS.2014.11.138. Epub 2014 Aug 10. Rev Diabet Stud. 2014. PMID: 25396402 Free PMC article. Review.
Glucose targets for preventing diabetic kidney disease and its progression.Cochrane Database Syst Rev. 2017 Jun 8;6(6):CD010137. doi: 10.1002/14651858.CD010137.pub2. Cochrane Database Syst Rev. 2017. PMID: 28594069 Free PMC article. Review.