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DM SEPTIC PATIENTS ARE ASSOCIATED WITH IMPAIRED IMMUNE RESPONSE BUT NOT POOR SURVIVAL IN ICU

Background and Aims: Diabetes mellitus (DM) is a widespread metabolic disorder. Without well control of blood glucose, numerous complications occurs in diabetic patients. Sepsis developed from various kinds of infections, complicated by multiple organ dysfunctions without effective management. DM grows the risk of developing infectious complications, including sepsis. DM is known to interface with numerous mechanisms of the immune system. The influence of DM on the results of sepsis is still disputed. We conducted a case-controlled study matched with propensity score to determine whether septic patients with DM associated with impaired immune response and poor clinical outcome ICU. Methods: A combined retrospective and prospective observational study from a cohort of adult sepsis patients admitted to three medical ICUs at Kaohsiung Chang Gung Memorial Hospital (KCGMH) in Taiwan between August 2013 and June 2016. Cytokine expressions were measured with a MILLIPLEX MAP Human Cytokine/Chemokine Panel (Merck Millipore, Billerica, MA, USA) in 12 patients enrolled to biomarker study. Expression of cell surface TLR4 MFI and HLADR MFI on monocytes was measured by flow cytometry (Cytomics FC500; Beckman Coulter, Inc., Fullerton, CA, USA). Results: This study evaluated adult medical ICU patients (18 y/o) with sepsis in KCGMH. Total 594 Patients with sepsis were identified and assessed for DM after adjustment of propensity score and there was no statistical significance change of Charson index, APACHE II score and comorbidity. DM patients had higher HbA1c, day 1, 3, 7 finger sugars (P < 0.05), lower Day (D)7 mortality (P < 0.05), lower D1 platelet count, higher systolic and pulse pressure, lower FiO2 of ventilators, lower D7 respiratory rate (P < 0.05), compared with patients without DM. DM patients also had lower D1IL10, lower D1 and 3 TLR4 expression and D7-VEGF. Conclusion: DM septic patients are associated with impaired immune response but not poor survival in ICU.