News Release: School of Medicine

Feb. 16,  2009

Combination of Diabetes and Sepsis Increases Likelihood of Renal Failure

Researchers have found that people with diabetes and sepsis are more likely to develop acute renal failure than people without diabetes; however, these same patients are less likely to develop acute respiratory failure.

The findings, recently published in BioMed Central's open access journal Critical Care, studied 930 million hospitalizations over a 25-year period.

Sepsis is a response to infection that can lead to widespread inflammation and blood clotting. It’s estimated that 1,400 people die each day from sepsis, according to the Surviving Sepsis Campaign.

Working with a team of researchers, Annette Esper, MD, and Greg Martin, MD, Emory University assistant professors of medicine in the Division of Pulmonary, Allergy and Critical Care Medicine, investigated suspected links between diabetes mellitus (DM) and the likelihood of experiencing different kinds of organ dysfunction during sepsis.

"We found that people with DM and sepsis were more likely to develop acute renal failure than people without DM, whereas they were less likely to develop acute respiratory failure. Findings like these are important because accurate identification of populations at risk for different acute organ dysfunctions is crucial to the development of novel therapies for these patients," says Martin.

An increasingly common illness, DM is believed to afflict seven percent of the US population.  Remarkably, it is present in 18 percent of patients with sepsis.

"We found that among patients with a respiratory source of sepsis, 16 percent of those with DM developed acute respiratory failure compared with 23 percent of people without DM. Among patients with a non-pulmonary source of sepsis, those with DM were still less likely to develop acute respiratory failure when compared with those without DM," says Martin.

The exact mechanisms behind these statistical differences are not yet clear. "Possible mechanisms of protection in patients with DM may be impaired neutrophil or macrophage function, particularly to reduce injury to the lung, or altered leukocyte-endothelial interactions," says Martin.

"Alternatively, patients with DM may be hospitalized earlier in the course of their illness than those with no DM because they learn to be aware of specific signs of infection. In addition, pharmacological aspects of DM care may also influence the development of organ dysfunction. Many medications administered to patients with DM, including insulin and thiazolidinediones, are known to have anti-inflammatory effects in addition to lowering blood glucose," says Esper.

This research was supported by the National Institutes of Health.

Reference: Annette Esper, Marc Moss, Greg S. Martin Critical Care 2009, 13:R18

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