Epidemiology, microbiology, and diagnosis of infection in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: A multicenter retrospective observational study
•Respiratory and urinary tract infections are common in hyperglycemic emergencies.•The mortality rate of patients with bacteremia was higher than patients without it.•C-reactive protein may be superior to procalcitonin in diagnosing bacteremia. We investigated the characteristics of infection and th...
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| Veröffentlicht in: | Diabetes research and clinical practice 2024-06, Vol.212, p.111713, Article 111713 |
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| creator | Takahashi, Kyosuke Uenishi, Norimichi Sanui, Masamitsu Uchino, Shigehiko Yonezawa, Naoki Takei, Tetsuhiro Nishioka, Norihiro Kobayashi, Hirotada Otaka, Shunichi Yamamoto, Kotaro Yasuda, Hideto Kosaka, Shintaro Tokunaga, Hidehiko Fujiwara, Naoki Kondo, Takashiro Ishida, Tomoki Komatsu, Takayuki Endo, Koji Moriyama, Taiki Oyasu, Takayoshi Hayakawa, Mineji Hoshino, Atsumi Matsuyama, Tasuku Miyamoto, Yuki Yanagisawa, Akihiro Wakabayashi, Tadamasa Ueda, Takeshi Komuro, Tetsuya Sugimoto, Toshiro Sasabuchi, Yusuke |
| description | •Respiratory and urinary tract infections are common in hyperglycemic emergencies.•The mortality rate of patients with bacteremia was higher than patients without it.•C-reactive protein may be superior to procalcitonin in diagnosing bacteremia.
We investigated the characteristics of infection and the utility of inflammatory markers in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS).
A multicenter, retrospective observational study in 21 acute-care hospitals was conducted in Japan. This study included adult hospitalized patients with DKA and HHS. We analyzed the diagnostic accuracy of markers including C-reactive protein (CRP) and procalcitonin (PCT) for bacteremia. Multiple regression models were created for estimating bacteremia risk factors.
A total of 771 patients, including 545 patients with DKA and 226 patients with HHS, were analyzed. The mean age was 58.2 (SD, 19.3) years. Of these, 70 tested positive for blood culture. The mortality rates of those with and without bacteremia were 14 % and 3.3 % (P-value |
| doi_str_mv | 10.1016/j.diabres.2024.111713 |
| format | Article |
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We investigated the characteristics of infection and the utility of inflammatory markers in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS).
A multicenter, retrospective observational study in 21 acute-care hospitals was conducted in Japan. This study included adult hospitalized patients with DKA and HHS. We analyzed the diagnostic accuracy of markers including C-reactive protein (CRP) and procalcitonin (PCT) for bacteremia. Multiple regression models were created for estimating bacteremia risk factors.
A total of 771 patients, including 545 patients with DKA and 226 patients with HHS, were analyzed. The mean age was 58.2 (SD, 19.3) years. Of these, 70 tested positive for blood culture. The mortality rates of those with and without bacteremia were 14 % and 3.3 % (P-value < 0.001). The area under the curve (AUC) of CRP and PCT for diagnosis of bacteremia was 0.85 (95 %CI, 0.81–0.89) and 0.76 (95 %CI, 0.60–0.92), respectively. Logistic regression models identified older age, altered level of consciousness, hypotension, and higher CRP as risk factors for bacteremia.
The mortality rate was higher in patients with bacteremia than patients without it. CRP, rather than PCT, may be valid for diagnosing bacteremia in hyperglycemic emergencies.
Trial Registration: This study is registered in the UMIN clinical trial registration system (UMIN000025393, Registered December 23, 2016)</description><identifier>ISSN: 0168-8227</identifier><identifier>ISSN: 1872-8227</identifier><identifier>EISSN: 1872-8227</identifier><identifier>DOI: 10.1016/j.diabres.2024.111713</identifier><identifier>PMID: 38772502</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Bacteremia ; Hyperglycemic emergency ; Inflammatory marker ; Sepsis</subject><ispartof>Diabetes research and clinical practice, 2024-06, Vol.212, p.111713, Article 111713</ispartof><rights>2024 Elsevier B.V.</rights><rights>Copyright © 2024 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c313t-b71ac724c609c3f5c602e09d7a22055c3cb940c08bfbdc78f31245384205a5da3</cites><orcidid>0000-0002-8730-2081 ; 0000-0001-7128-8601 ; 0000-0003-4068-0306 ; 0000-0001-7828-0549 ; 0000-0001-8341-7626 ; 0000-0003-2557-5698 ; 0000-0003-2246-4650</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0168822724006235$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38772502$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Takahashi, Kyosuke</creatorcontrib><creatorcontrib>Uenishi, Norimichi</creatorcontrib><creatorcontrib>Sanui, Masamitsu</creatorcontrib><creatorcontrib>Uchino, Shigehiko</creatorcontrib><creatorcontrib>Yonezawa, Naoki</creatorcontrib><creatorcontrib>Takei, Tetsuhiro</creatorcontrib><creatorcontrib>Nishioka, Norihiro</creatorcontrib><creatorcontrib>Kobayashi, Hirotada</creatorcontrib><creatorcontrib>Otaka, Shunichi</creatorcontrib><creatorcontrib>Yamamoto, Kotaro</creatorcontrib><creatorcontrib>Yasuda, Hideto</creatorcontrib><creatorcontrib>Kosaka, Shintaro</creatorcontrib><creatorcontrib>Tokunaga, Hidehiko</creatorcontrib><creatorcontrib>Fujiwara, Naoki</creatorcontrib><creatorcontrib>Kondo, Takashiro</creatorcontrib><creatorcontrib>Ishida, Tomoki</creatorcontrib><creatorcontrib>Komatsu, Takayuki</creatorcontrib><creatorcontrib>Endo, Koji</creatorcontrib><creatorcontrib>Moriyama, Taiki</creatorcontrib><creatorcontrib>Oyasu, Takayoshi</creatorcontrib><creatorcontrib>Hayakawa, Mineji</creatorcontrib><creatorcontrib>Hoshino, Atsumi</creatorcontrib><creatorcontrib>Matsuyama, Tasuku</creatorcontrib><creatorcontrib>Miyamoto, Yuki</creatorcontrib><creatorcontrib>Yanagisawa, Akihiro</creatorcontrib><creatorcontrib>Wakabayashi, Tadamasa</creatorcontrib><creatorcontrib>Ueda, Takeshi</creatorcontrib><creatorcontrib>Komuro, Tetsuya</creatorcontrib><creatorcontrib>Sugimoto, Toshiro</creatorcontrib><creatorcontrib>Sasabuchi, Yusuke</creatorcontrib><title>Epidemiology, microbiology, and diagnosis of infection in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: A multicenter retrospective observational study</title><title>Diabetes research and clinical practice</title><addtitle>Diabetes Res Clin Pract</addtitle><description>•Respiratory and urinary tract infections are common in hyperglycemic emergencies.•The mortality rate of patients with bacteremia was higher than patients without it.•C-reactive protein may be superior to procalcitonin in diagnosing bacteremia.
We investigated the characteristics of infection and the utility of inflammatory markers in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS).
A multicenter, retrospective observational study in 21 acute-care hospitals was conducted in Japan. This study included adult hospitalized patients with DKA and HHS. We analyzed the diagnostic accuracy of markers including C-reactive protein (CRP) and procalcitonin (PCT) for bacteremia. Multiple regression models were created for estimating bacteremia risk factors.
A total of 771 patients, including 545 patients with DKA and 226 patients with HHS, were analyzed. The mean age was 58.2 (SD, 19.3) years. Of these, 70 tested positive for blood culture. The mortality rates of those with and without bacteremia were 14 % and 3.3 % (P-value < 0.001). The area under the curve (AUC) of CRP and PCT for diagnosis of bacteremia was 0.85 (95 %CI, 0.81–0.89) and 0.76 (95 %CI, 0.60–0.92), respectively. Logistic regression models identified older age, altered level of consciousness, hypotension, and higher CRP as risk factors for bacteremia.
The mortality rate was higher in patients with bacteremia than patients without it. CRP, rather than PCT, may be valid for diagnosing bacteremia in hyperglycemic emergencies.
Trial Registration: This study is registered in the UMIN clinical trial registration system (UMIN000025393, Registered December 23, 2016)</description><subject>Bacteremia</subject><subject>Hyperglycemic emergency</subject><subject>Inflammatory marker</subject><subject>Sepsis</subject><issn>0168-8227</issn><issn>1872-8227</issn><issn>1872-8227</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqFkctu2zAQRYkiReOm_YQUXGYRu3yIJp1NEATpAwjQTbsm-Bi5dCRRJSUD-qN8ZqnI6barGWLOnQvOReiSkg0ldPv5sPHB2AR5wwirNpRSSfkbtKJKsrViTJ6hVeHUS3-O3ud8IIRseSXeoXOupGSCsBV6fuiDhzbEJu6na9wGl6J9fZnO4-Ky72IOGccah64GN4TYlW6eWBiCw08wROOCf6Fmze-phxRzGxuTlse-mVxxcThPnU-xhRt8h9uxKXLoBkg4wVAU_bz9CDjaDOloZifT4DyMfvqA3tamyfDxVC_Qry8PP--_rR9_fP1-f_e4dpzyYW0lNU6yym3JzvFalMqA7Lw0jBEhHHd2VxFHlK2td1LVnLJKcFWVqRHe8At0teztU_wzQh50G7KDpjEdxDFrToTaclUEBRULWm6Wc4Ja9ym0Jk2aEj2HpA_6FJKeQ9JLSEX36WQx2hb8P9VrKgW4XQAoHz0GSDq7AJ0DH1K5kPYx_MfiLxKzqrY</recordid><startdate>20240601</startdate><enddate>20240601</enddate><creator>Takahashi, Kyosuke</creator><creator>Uenishi, Norimichi</creator><creator>Sanui, Masamitsu</creator><creator>Uchino, Shigehiko</creator><creator>Yonezawa, Naoki</creator><creator>Takei, Tetsuhiro</creator><creator>Nishioka, Norihiro</creator><creator>Kobayashi, Hirotada</creator><creator>Otaka, Shunichi</creator><creator>Yamamoto, Kotaro</creator><creator>Yasuda, Hideto</creator><creator>Kosaka, Shintaro</creator><creator>Tokunaga, Hidehiko</creator><creator>Fujiwara, Naoki</creator><creator>Kondo, Takashiro</creator><creator>Ishida, Tomoki</creator><creator>Komatsu, Takayuki</creator><creator>Endo, Koji</creator><creator>Moriyama, Taiki</creator><creator>Oyasu, Takayoshi</creator><creator>Hayakawa, Mineji</creator><creator>Hoshino, Atsumi</creator><creator>Matsuyama, Tasuku</creator><creator>Miyamoto, Yuki</creator><creator>Yanagisawa, Akihiro</creator><creator>Wakabayashi, Tadamasa</creator><creator>Ueda, Takeshi</creator><creator>Komuro, Tetsuya</creator><creator>Sugimoto, Toshiro</creator><creator>Sasabuchi, Yusuke</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8730-2081</orcidid><orcidid>https://orcid.org/0000-0001-7128-8601</orcidid><orcidid>https://orcid.org/0000-0003-4068-0306</orcidid><orcidid>https://orcid.org/0000-0001-7828-0549</orcidid><orcidid>https://orcid.org/0000-0001-8341-7626</orcidid><orcidid>https://orcid.org/0000-0003-2557-5698</orcidid><orcidid>https://orcid.org/0000-0003-2246-4650</orcidid></search><sort><creationdate>20240601</creationdate><title>Epidemiology, microbiology, and diagnosis of infection in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: A multicenter retrospective observational study</title><author>Takahashi, Kyosuke ; Uenishi, Norimichi ; Sanui, Masamitsu ; Uchino, Shigehiko ; Yonezawa, Naoki ; Takei, Tetsuhiro ; Nishioka, Norihiro ; Kobayashi, Hirotada ; Otaka, Shunichi ; Yamamoto, Kotaro ; Yasuda, Hideto ; Kosaka, Shintaro ; Tokunaga, Hidehiko ; Fujiwara, Naoki ; Kondo, Takashiro ; Ishida, Tomoki ; Komatsu, Takayuki ; Endo, Koji ; Moriyama, Taiki ; Oyasu, Takayoshi ; Hayakawa, Mineji ; Hoshino, Atsumi ; Matsuyama, Tasuku ; Miyamoto, Yuki ; Yanagisawa, Akihiro ; Wakabayashi, Tadamasa ; Ueda, Takeshi ; Komuro, Tetsuya ; Sugimoto, Toshiro ; Sasabuchi, Yusuke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c313t-b71ac724c609c3f5c602e09d7a22055c3cb940c08bfbdc78f31245384205a5da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Bacteremia</topic><topic>Hyperglycemic emergency</topic><topic>Inflammatory marker</topic><topic>Sepsis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Takahashi, Kyosuke</creatorcontrib><creatorcontrib>Uenishi, Norimichi</creatorcontrib><creatorcontrib>Sanui, Masamitsu</creatorcontrib><creatorcontrib>Uchino, Shigehiko</creatorcontrib><creatorcontrib>Yonezawa, Naoki</creatorcontrib><creatorcontrib>Takei, Tetsuhiro</creatorcontrib><creatorcontrib>Nishioka, Norihiro</creatorcontrib><creatorcontrib>Kobayashi, Hirotada</creatorcontrib><creatorcontrib>Otaka, Shunichi</creatorcontrib><creatorcontrib>Yamamoto, Kotaro</creatorcontrib><creatorcontrib>Yasuda, Hideto</creatorcontrib><creatorcontrib>Kosaka, Shintaro</creatorcontrib><creatorcontrib>Tokunaga, Hidehiko</creatorcontrib><creatorcontrib>Fujiwara, Naoki</creatorcontrib><creatorcontrib>Kondo, Takashiro</creatorcontrib><creatorcontrib>Ishida, Tomoki</creatorcontrib><creatorcontrib>Komatsu, Takayuki</creatorcontrib><creatorcontrib>Endo, Koji</creatorcontrib><creatorcontrib>Moriyama, Taiki</creatorcontrib><creatorcontrib>Oyasu, Takayoshi</creatorcontrib><creatorcontrib>Hayakawa, Mineji</creatorcontrib><creatorcontrib>Hoshino, Atsumi</creatorcontrib><creatorcontrib>Matsuyama, Tasuku</creatorcontrib><creatorcontrib>Miyamoto, Yuki</creatorcontrib><creatorcontrib>Yanagisawa, Akihiro</creatorcontrib><creatorcontrib>Wakabayashi, Tadamasa</creatorcontrib><creatorcontrib>Ueda, Takeshi</creatorcontrib><creatorcontrib>Komuro, Tetsuya</creatorcontrib><creatorcontrib>Sugimoto, Toshiro</creatorcontrib><creatorcontrib>Sasabuchi, Yusuke</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetes research and clinical practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Takahashi, Kyosuke</au><au>Uenishi, Norimichi</au><au>Sanui, Masamitsu</au><au>Uchino, Shigehiko</au><au>Yonezawa, Naoki</au><au>Takei, Tetsuhiro</au><au>Nishioka, Norihiro</au><au>Kobayashi, Hirotada</au><au>Otaka, Shunichi</au><au>Yamamoto, Kotaro</au><au>Yasuda, Hideto</au><au>Kosaka, Shintaro</au><au>Tokunaga, Hidehiko</au><au>Fujiwara, Naoki</au><au>Kondo, Takashiro</au><au>Ishida, Tomoki</au><au>Komatsu, Takayuki</au><au>Endo, Koji</au><au>Moriyama, Taiki</au><au>Oyasu, Takayoshi</au><au>Hayakawa, Mineji</au><au>Hoshino, Atsumi</au><au>Matsuyama, Tasuku</au><au>Miyamoto, Yuki</au><au>Yanagisawa, Akihiro</au><au>Wakabayashi, Tadamasa</au><au>Ueda, Takeshi</au><au>Komuro, Tetsuya</au><au>Sugimoto, Toshiro</au><au>Sasabuchi, Yusuke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiology, microbiology, and diagnosis of infection in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: A multicenter retrospective observational study</atitle><jtitle>Diabetes research and clinical practice</jtitle><addtitle>Diabetes Res Clin Pract</addtitle><date>2024-06-01</date><risdate>2024</risdate><volume>212</volume><spage>111713</spage><pages>111713-</pages><artnum>111713</artnum><issn>0168-8227</issn><issn>1872-8227</issn><eissn>1872-8227</eissn><abstract>•Respiratory and urinary tract infections are common in hyperglycemic emergencies.•The mortality rate of patients with bacteremia was higher than patients without it.•C-reactive protein may be superior to procalcitonin in diagnosing bacteremia.
We investigated the characteristics of infection and the utility of inflammatory markers in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS).
A multicenter, retrospective observational study in 21 acute-care hospitals was conducted in Japan. This study included adult hospitalized patients with DKA and HHS. We analyzed the diagnostic accuracy of markers including C-reactive protein (CRP) and procalcitonin (PCT) for bacteremia. Multiple regression models were created for estimating bacteremia risk factors.
A total of 771 patients, including 545 patients with DKA and 226 patients with HHS, were analyzed. The mean age was 58.2 (SD, 19.3) years. Of these, 70 tested positive for blood culture. The mortality rates of those with and without bacteremia were 14 % and 3.3 % (P-value < 0.001). The area under the curve (AUC) of CRP and PCT for diagnosis of bacteremia was 0.85 (95 %CI, 0.81–0.89) and 0.76 (95 %CI, 0.60–0.92), respectively. Logistic regression models identified older age, altered level of consciousness, hypotension, and higher CRP as risk factors for bacteremia.
The mortality rate was higher in patients with bacteremia than patients without it. CRP, rather than PCT, may be valid for diagnosing bacteremia in hyperglycemic emergencies.
Trial Registration: This study is registered in the UMIN clinical trial registration system (UMIN000025393, Registered December 23, 2016)</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>38772502</pmid><doi>10.1016/j.diabres.2024.111713</doi><orcidid>https://orcid.org/0000-0002-8730-2081</orcidid><orcidid>https://orcid.org/0000-0001-7128-8601</orcidid><orcidid>https://orcid.org/0000-0003-4068-0306</orcidid><orcidid>https://orcid.org/0000-0001-7828-0549</orcidid><orcidid>https://orcid.org/0000-0001-8341-7626</orcidid><orcidid>https://orcid.org/0000-0003-2557-5698</orcidid><orcidid>https://orcid.org/0000-0003-2246-4650</orcidid></addata></record> |
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| ispartof | Diabetes research and clinical practice, 2024-06, Vol.212, p.111713, Article 111713 |
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| source | Elsevier ScienceDirect Journals |
| subjects | Bacteremia Hyperglycemic emergency Inflammatory marker Sepsis |
| title | Epidemiology, microbiology, and diagnosis of infection in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: A multicenter retrospective observational study |
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