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Laura Menezes Silveira1 
, Simone Costa Silva1 , Mariele Lenhari1 , Thaissa Pinto de Melo1 , Antônio Ruffino-Netto2 , Angelita Maria Stabile *3
, Simone Costa Silva1 , Mariele Lenhari1 , Thaissa Pinto de Melo1 , Antônio Ruffino-Netto2 , Angelita Maria Stabile *3
1- University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
2- Department of Social Medicine, Hospital of the Ribeirão Preto Medical School, Ribeirão Preto, Brazil
3- University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil ,angelita@eerp.usp.br
2- Department of Social Medicine, Hospital of the Ribeirão Preto Medical School, Ribeirão Preto, Brazil
3- University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil ,
Abstract: (27 Views)
Background: Sepsis is characterized by a set of physiological reactions that occur in an unregulated manner in response to an infection. Type 2 diabetes mellitus (T2DM) is a common comorbidity of patients with sepsis. This study aimed to compare the clinical outcomes and nursing workload of patients with sepsis with and without T2DM, as well as to describe their admission characteristics, clinical progression, and blood glucose levels.
Methods: This retrospective cohort study reviewed medical records of adult intensive care patients at a high-complexity, public, tertiary hospital in São Paulo, Brazil. From 2015-2019, two groups of 102 patients (with and without T2DM) were consecutively included. Data collected encompassed sociodemographic, clinical admission data (including prognostic scores like Sequential Organ Failure Assessment [SOFA], Simplified Acute Physiology Score III [SAPS III], and Acute Physiology and Chronic Health Evaluation II [APACHE II]), ICU progression, patients’ outcomes (e.g., ICU discharge or death), blood glucose levels, and glycemic variability (GV). Nursing workload was assessed by the Nursing Activity Score (NAS). Statistical analysis used SPSS (v.25) using Student t-test or Mann-Whitney test for numerical variables, and Pearson’s Chi-square test or Fisher’s exact test for categorical variables. The level of statistical significance adopted was p < 0.05.
Results: T2DM patients showed higher mortality (p=0.012), elevated prognostic scores (APACHE II p=0.035, SAPS III p=0.033), and greater glycemic variability (p<0.001 for all related metrics) compared to non-T2DM patients. While NAS was similar between groups (p=0.644), it was associated with death in both (p=0.000 and p=0.007, respectively).
Conclusion: T2DM significantly influences both ICU and hospital outcomes, leading to higher mortality rates in sepsis patients. The T2DM group presented with more severe admission conditions (indicated by higher APACHE II, SAPS III, and a greater number of comorbidities) and exhibited higher average blood glucose and greater glycemic variability. While overall NAS was similar, a higher NAS was consistently associated with mortality, highlighting heightened care demands for critically ill patients who progress to death.
Methods: This retrospective cohort study reviewed medical records of adult intensive care patients at a high-complexity, public, tertiary hospital in São Paulo, Brazil. From 2015-2019, two groups of 102 patients (with and without T2DM) were consecutively included. Data collected encompassed sociodemographic, clinical admission data (including prognostic scores like Sequential Organ Failure Assessment [SOFA], Simplified Acute Physiology Score III [SAPS III], and Acute Physiology and Chronic Health Evaluation II [APACHE II]), ICU progression, patients’ outcomes (e.g., ICU discharge or death), blood glucose levels, and glycemic variability (GV). Nursing workload was assessed by the Nursing Activity Score (NAS). Statistical analysis used SPSS (v.25) using Student t-test or Mann-Whitney test for numerical variables, and Pearson’s Chi-square test or Fisher’s exact test for categorical variables. The level of statistical significance adopted was p < 0.05.
Results: T2DM patients showed higher mortality (p=0.012), elevated prognostic scores (APACHE II p=0.035, SAPS III p=0.033), and greater glycemic variability (p<0.001 for all related metrics) compared to non-T2DM patients. While NAS was similar between groups (p=0.644), it was associated with death in both (p=0.000 and p=0.007, respectively).
Conclusion: T2DM significantly influences both ICU and hospital outcomes, leading to higher mortality rates in sepsis patients. The T2DM group presented with more severe admission conditions (indicated by higher APACHE II, SAPS III, and a greater number of comorbidities) and exhibited higher average blood glucose and greater glycemic variability. While overall NAS was similar, a higher NAS was consistently associated with mortality, highlighting heightened care demands for critically ill patients who progress to death.
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