Abstract:

Objective To explore the relationship of glycated hemoglobin with organ dysfunction progres⁃ sion and ICU mortality in diabetes with sepsis. Methods 102 diabetes with sepsis admitted in the department of Intensive Care Unit of the First Aftiliated Hospital of Soochow University from May 2018 to June 2019 were divided into the two group according to the level of glycated hemoglobin：the abnormal glycated hemoglobin group （HbA1c ≥ 6.5%）and the normal glycated hemoglobin group（HbA1c < 6.5%）. Survival analysis was performed by kaplan⁃Meier method and log⁃rank test.Logistic regression analysis and Cox regression analysis were used to study the influencing factors of the progression of organ dysfunction and ICU mortality. Results Among the 102 patients， 39 were in the group with abnormal glycated hemoglobin and 63 were in the group with normal glycated hemoglo⁃ bin. The incidence of organ dysfunction progression in the abnormal group was significantly higher than that in the normal group（48.7% vs. 22.2%，P = 0.001）. The ICU mortality in the abnormal group was significantly higher than that in the normal group（38.5% vs. 7.9% ，P < 0.001）. Multivariate Logistic regression analysis showed that HbA1c ≥ 6.5%（OR = 1.070，95% CI：1.006 ~ 1.138，P = 0.031）and lactic acid level（OR = 1.557，95%CI：1.166 ~ 2.081，P = 0.003）were independent risk factors for the progression of organ dysfunction. Kaplan⁃Meier analysis along with the log⁃rank test showed that the survival period was significantly shorter in patients with an HbA1c level ≥ 6.5% than in those with an HbA1c level < 6.5%（P < 0.001）. Multivariable Cox proportional hazard analysis with backward elimination indicated that HbA1c ≥ 6.5%（HR = 1.394，95% CI：1.157 ~ 1.678，P < 0.001），high lactic acid level（HR = 1.555，95%CI：1.165 ~ 2.077，P = 0.003）and age（HR = 1.080，95%CI：1.004 ~ 1.162，P = 0.039） were significant，independent predictors of ICU mortality. Conclusions In diabetes with sepsis，higher glycated hemoglobin at ICU admission is associated with progression of organ dysfunction and ICU mortality.

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