无创血流动力学监测指导严重脓毒症患者血管活性药物的应用

目的:探讨无创血流动力学监测技术在严重脓毒症患者液体复苏后指导血管活性药物使用的意义。方法:选择2014年6月至2016年6月我院急诊处收治的严重脓毒症患者56例为研究对象,分为观察组和对照组,每组各28例。对照组进行常规对症治疗,观察组在对照组治疗基础上使用无创血流动力学监测仪指导治疗。观察两组患者在治疗前及治疗后6 h血流动力学及微循环灌注指标、液体复苏6 h后液体平衡量及血管活性药物使用量,及在重症监护病房(EICU)的入住时间。结果:治疗后两组患者尿量均大于30 m L/h,提示复苏成功。两组患者治疗后血液动力学指标和微循环灌注指标较治疗前均明显好转(均P0.05);治疗后,两组间血液动力学指标和微循环灌注指标比较无明显差异(P0.05)。观察组液体复苏6 h后液体平衡量明显少于对照组(P0.05),观察组血管活性药物用量均明显高于对照组(P0.05),观察组患者在EICU病房住院时间明显短于对照组(P0.05)。结论:无创血流动力学监测对严重脓毒症患者的液体恢复管理和治疗过程具有指导意义,使血管活性药物得到有效利用,精确进行液体管理,减少盲目补液,缩短病程,减少患者的住院时间,经济高效,是指导治疗和评估治疗疗效的重要手段。     

老年脓毒症和脓毒性休克患者30天死亡率的危险因素分析

目的:探讨就诊于急诊室诊断为脓毒症或者脓毒性休克的患者30天内死亡率与在急诊室初次获得的参数的关系,并探讨死亡率的危险因素。方法:选取2014年6月到2017年6月就诊于我院急诊室且诊断为脓毒血症或者脓毒性休克并有完整随访资料大于65岁的老年患者145例,将30天内存活的患者分为A组,将30天内死亡的患者分为B组,比较两组之间检验指标及生命体征的差异。根据脓毒症序贯器官衰竭评估快速评分(qSOFA)将qSOFA2分的定义为a组,qSOFA≥2分的定义为b组,比较两组的死亡率。并采用二项Logistic回归分析探讨30天死亡率的独立危险因素。结果:145例患者中,44.8%(n=65)的患者在30天内死亡,33.1%(n=48)的患者需要无创或者侵入性机械通气。A组与B组之间舒张压(P=0.003)、收缩压(P=0.002)、格拉斯哥昏迷量表评分(GCS)(P0.001)、血尿素氮(P0.001)及qSOFA(P0.001)比较均具有统计学差异。a组死亡率(35.7%)显著低于b组(53.3%)(P=0.033)。qSOFA是30天内死亡率的独立危险因素(OR=2.871,P=0.004)。结论:qSOFA是老年脓毒症及脓毒性休克患者30天内死亡的的独立危险因素。     

老年患者脓毒性休克液体复苏速度与预后的关系

目的探讨老年患者脓毒性休克液体复苏过程中输液速度与预后的相关性。方法回顾性分析92例严重感染病人液体复苏效果。按液体复苏期间的输液速度分为慢速组（〈500ml/h）和快速组（≥500ml/h）,并对两组患者的心率、有创及无创血压、血氧饱和度、呼吸、中心静脉压（CVP）、每小时尿量、尿比重、血乳酸、ScVO2及有无发生肺水肿、急性心功能不全、急性肾功能不全、MODS和7天死亡率、28天死亡率及入住ICU时间、住院时间等指标进行分析比较。结果两组患者在液体复苏过程中CVP和MAP两项指标比较无统计学意义。慢速组的尿量达标时间耗时较长（P〈0.05）;ScVO2及乳酸清除率比较无明显差异。快速组对液体的需求量多,而应用血管活性药物的病例数则少于慢速组;发生肺水肿、急性心功能不全的比例高于慢速组（P〈0.05）。两组急性肾功能不全的发生率相近,但慢速组出现MODS的例数少（P〈0.05）。7天死亡率和28天死亡率比较,慢速组低于快速组,但无统计学意义。两组患者住院时间无显著统计学意义,入住ICU时间慢速组明显短于快速组（P〈0.05）。结论在脓毒性休克复苏过程中不可一味靠加快输液速度来保证组织灌注,尤其对于老年患者,更应控制单位时间内的输液量,避免给储备能力较差的心功能造成更大的负担。在保证主要脏器灌注的情况下可以适当应用血管活性药物。     

严重多发创伤失血性休克患者限制性液体复苏的临床应用评价

目的:评价限制性液体复苏在严重多发失血性休克救治中的作用.方法:对88例多发创伤合并失血性休克的患者随机分为两组,观察组(n=48)在创伤失血性休克出血未控制前行限制性液体复苏,对照组(n=40)则进行常规行充分液体复苏.比较两组的液体摄入量、输血量、收缩压、术前复苏时间;住院期间急性呼吸窘迫综合征(ARDS)、急性肾功能衰竭(ARF)、弥漫性血管内凝血(DIC)、脓毒血症的发生率和总死亡率.结果:观察组的液体输入量和术前复苏时间均低于对照组,差异有显著性(P＜0.05);两组输血量和收缩压差异无显著性.观察组ARDS、脓毒血症的发生率和总死亡率均明显低于对照组,差异有显著性(P＜0.05).结论:在创伤性休克术前未控制性出血条件下,限制性液体复苏可缩短术前复苏时间,明显降低并发症的发生率和死亡率.     

乌司他丁联合连续性肾脏替代治疗对严重脓毒症患者炎症反应和血流动力学的影响

目的:探讨乌司他丁联合连续性肾脏替代(CRRT)治疗对严重脓毒症患者炎症反应和血流动力学的影响。方法:选取2015年5月～2019年4月期间我院收治的严重脓毒症患者119例,将所有患者根据随机数字表法分为对照组(n=59)和研究组(n=60),对照组给予CRRT治疗,研究组在对照组基础上联合乌司他丁治疗,比较两组患者临床疗效、炎症反应指标、血流动力学参数,记录两组患者住院时间及28d内病死率。结果:研究组治疗7 d后的临床总有效率高于对照组(P0.05)。两组治疗7 d后血清白介素-6(IL-6)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平均下降,且研究组低于对照组(P0.05)。两组患者治疗7 d后心率、平均动脉压(MAP)、血乳酸下降,氧合指数升高(P0.05),研究组治疗7 d后氧合指数高于对照组,血乳酸则低于对照组(P0.05)。研究组住院时间短于对照组(P0.05),两组28d内病死率比较无统计学差异(P0.05)。结论:乌司他丁联合CRRT治疗严重脓毒症患者的疗效确切,可有效抑制机体炎症反应,改善血流动力学,减少住院时间,具有一定的临床应用价值。     

限制性液体复苏与常规液体复苏对失血性休克患者临床疗效分析

目的:探讨限制性液体复苏与常规液体复苏对失血性休克患者死亡率、凝血功能及并发症的影响。方法:选取失血性休克患者100例,随机分为限制组(n=55)和常规组(n=45),其中限制组采用限制性液体复苏抗休克,而常规组采用常规液体复苏。比较两组患者输液量及死亡率、血压与检验指标、并发症发生率。结果:与常规组相比,限制组患者输液量较少,死亡率较低,痊愈率较高,差异有统计学意义(P0.05)。与常规组相比,限制组患者平均动脉压、碱剩余明显较低,血红蛋白、血小板、红细胞比容明显较高,凝血酶原时间明显较短,差异有统计学意义(P0.001)。与常规组相比,限制组患者急性呼吸窘迫综合征、多器官功能障碍综合征发生率较低,差异有统计学意义(P0.05)。结论:限制性液体复苏为失血性休克患者赢得更多后续急诊手术止血时间,能降低患者死亡率和并发症如急性呼吸窘迫综合征、多器官功能障碍综合征的发生率。     

脓毒症诊断的生物学标志物的研究进展

脓毒症是由致病微生物感染引发的全身炎症反应综合征(SIRS),合并血压降低且经快速液体复苏后血压仍不能恢复正常者称为脓毒性休克(Septic shock),其中一部分患者发展为多器官功能障碍综合症(MODS)。由于目前临床上仍缺乏早期敏感性诊断手段,脓毒症病死率居高不下。每10万人口中约50-300人会发生严重脓毒症,其短期死亡率达20%-25%,当发展为脓毒性休克时其死亡率达50%。随着分子生物学和现代生物技术的不断发展,人们发现多种生物标志物在脓毒症的早期诊断、病情及预后判断,疗效评估中发挥重要作用。因此深入了解脓毒症病理生理机制中不同生物标志物的意义及价值,对于脓毒症及其并发症的早期识别及干预,降低患者病死率及改善患者生活质量有积极意义。本文综述了近几年来对脓毒症的诊断和预后有一定价值的主要标志物及其应用。     

血栓弹力图联合凝血指标评估脓毒症病情严重程度的临床价值分析

目的:探讨血栓弹力图(TEG)联合常规凝血指标评估脓毒症病情严重程度的临床价值。方法:选取2015年11月-2016年11月兰州军区兰州总医院重症医学科收治的重症感染患者97例为研究对象。依据脓毒症3.0将患者分为脓毒症(Sepsis)组(67例)、脓毒症休克(Septic Shock)组(30例)。完善相关检查后,检测和比较两组常规凝血功能指标(活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)),描绘TEG(血凝时间(R)、血块成型时间(K)、α角、血块强度(MA))的差异及以上指标之间的相关性。结果:脓毒症休克组PT、APTT、FIB和D-D水平均较脓毒症组显著升高(P0.05),R、K均较脓毒症组显著缩短(P0.05),而α角、MA均较脓毒症组显著增大(P0.05)。TEG中R值、K值与PT、APTT呈正相关(r=0.439、0.267、0.379、0.136),与FIB、D-D呈负相关(r=-0.397、-0.671、-0.628、-0.534);α角、MA值与PT、APTT呈负相关(r=-0.127、-0.238、-0.459、-0.213),与FIB、D-D呈正相关(r=0.386、0.53、0.687、0.652)。结论:TEG联合凝血指标可较真实地判断脓毒症患者凝血纤溶状态,为脓毒症患者病情严重程度的判断提供更可靠的依据。     

中心静脉-动脉血二氧化碳分压差联合中心静脉血氧饱和度指导感染性休克患者液体复苏的应用效果及预后的危险因素分析

摘要 目的：探讨中心静脉-动脉血二氧化碳分压差[P（cv-a）CO₂]联合中心静脉血氧饱和度（ScvO₂）指导感染性休克患者液体复苏的应用效果及预后的危险因素。方法：选取2020年1月-2021年12月我院收治的230例感染性休克患者,按照随机数字表法分为对照组（n=115,以ScvO₂为目标指导液体复苏）和观察租[n=115,P（cv-a）CO₂联合ScvO₂指导液体复苏],比较两组复苏前、复苏6 h后的相关监测指标,比较两组住院期间治疗相关指标。此外,根据入院后28 d生存预后将患者分为死亡组和生存组,采用多因素Logistic回归分析感染性休克患者死亡的危险因素。结果：复苏6 h后,两组患者的平均动脉压（MAP）、中心静脉压（CVP）、ScvO₂、心脏指数（CI）较复苏前升高,且观察组高于对照组（P＜0.05）,两组患者的血肌酐（Scr）水平、急性生理学与慢性健康状况（APACHEⅡ）评分、序贯器官衰竭（SOFA）评分较复苏前降低,且观察组低于对照组（P＜0.05）;复苏6 h后观察组的6 h平均入液量、乳酸清除率高于对照组（P＜0.05）。观察组ICU入住时间、机械通气时间、住院时间较对照组短（P＜0.05）。单因素分析结果显示,相较于生存组患者,死亡组患者的年龄更大、APACHEⅡ评分、SOFA评分更高、机械通气时间、入住ICU时间、住院时间更久、CI、血酸清除率、ScvO₂更低（P＜0.05）。多因素Logistic回归分析结果显示,APACHEⅡ评分≥30分、SOFA评分≥8分、血乳酸清除率＜30%、ScvO₂＜53%是感染性休克患者死亡的危险因素（P＜0.05）。结论：P（cv-a）CO₂联合ScvO₂指导感染性休克患者液体复苏效果明显,有利于提高复苏作用和改善患者预后。较高的APACHEⅡ评分、SOFA评分以及较低的血乳酸清除率、ScvO₂是感染性休克患者不良预后的危险因素,临床应针对性干预。     

糖皮质激素在脓毒症治疗中的研究进展

脓毒症是由致病微生物感染引发的全身炎症反应综合征（SIRS),合并血压降低且经快速液体复苏后血压仍不能恢复正常者 称为脓毒性休克（Septic shock),其中一部分患者发展为多器官功能障碍综合症(MODS)。脓毒症病死率居高不下。每10 万人口中 约50-300 人会发生严重脓毒症,其短期死亡率达20%-25%,当发展为脓毒性休克时其死亡率达50%。整合消灭致病微生物、阻断 炎症介质和处理MODS等措施的" 集束化"治疗并未显著降低脓毒症患者的病死率。糖皮质激素具有强大的抗炎作用,但诸多 的临床研究对糖皮质激素疗效的评价褒贬不一,糖皮质激素是否有利于脓毒症的转归一直饱受争议[3]。本文仅就糖皮质激素在 严重脓毒症及脓毒性休克中的治疗进展综述如下,并希望能进一步探讨发生严重脓毒症及脓毒性休克时,机体对糖皮质激素反 应复杂性的原因,以及在以后的研究中对相对肾上腺皮质功能不全的诊断标准及对糖皮质激素用药和停药时机的选择更加明确。     

Prognostic Value of Lactate and Central Venous Oxygen Saturation after Early Resuscitation in Sepsis Patients

The objective of this study was to evaluate the prognostic value of static and dynamic variables of central venous oxygen saturation (ScvO₂) and lactate in patients with severe sepsis or septic shock who underwent early quantitative resuscitation. We also investigated whether ScvO₂ measured after initial resuscitation could provide additive prognostic value to that of lactate. We analyzed the sepsis registry for patients presenting to the emergency department and included patients with simultaneous measurements of lactate and ScvO₂ at the time of presentation (H0) and 6 hours (H6) after resuscitation. The primary outcome was 28-day mortality and multivariable logistic analysis was used to adjust for confounders. A total of 363 patients were included, and the overall 28-day mortality was 18%. The area under the receiver operator characteristic curve for predicting 28-day mortality was as follows: lactate (H6), 0.81; lactate (H0), 0.73; relative lactate change, 0.67; ScvO₂ (H6), 0.65; relative ScvO₂ change 0.59; ScvO₂ (H0), 0.58. Patients with lactate normalization showed significantly lower 28-day mortality compared to patients without lactate normalization (3% vs. 28%, P<0.01). However, in those who achieved ScvO₂ (H6) ≥70%, there was a significant difference in 28-mortality only in patients without lactate normalization (21% vs. 39%, P<0.01) but no difference in those with lactate normalization (4% vs. 3%, P = 0.71). In multivariable analysis, lactate normalization was significantly associated with 28-day mortality (adjusted odds ratio [OR] for 28-day mortality, 0.20; 95% confidence interval [CI], 0.07–0.54; P <0.01), but ScvO₂ (H6) ≥70% showed only a marginal association (the adjusted OR for 28-day mortality, 0.51; 95% CI, 0.26–1.01; P = 0.05). ScvO₂ (H6) ≥70% was associated with 28-day mortality only in cases without lactate normalization in subgroup analysis (adjusted OR 0.37, 95% CI, 0.18–0.79; P = 0.01). Six-hour lactate was the strongest predictor of 28-day mortality in patients with severe sepsis or septic shock. Six-hour ScvO₂ provided additional prognostic value only in cases where lactate values were not normalized after resuscitation.     

Clinical Usefulness of Procalcitonin and C-Reactive Protein as Outcome Predictors in Critically Ill Patients with Severe Sepsis and Septic Shock

Sepsis is a major cause of mortality and morbidity in critically ill patients. Procalcitonin (PCT) and C-reactive protein (CRP) are the most frequently used biomarkers in sepsis. We investigated changes in PCT and CRP concentrations in critically ill patients with sepsis to determine which biochemical marker better predicts outcome. We retrospectively analyzed 171 episodes in 157 patients with severe sepsis and septic shock who were admitted to the Samsung Medical Center intensive care unit from March 2013 to February 2014. The primary endpoint was patient outcome within 7 days from ICU admission (treatment failure). The secondary endpoint was 28-day mortality. Severe sepsis was observed in 42 (25%) episodes from 41 patients, and septic shock was observed in 129 (75%) episodes from 120 patients. Fifty-five (32%) episodes from 42 patients had clinically-documented infection, and 116 (68%) episodes from 99 patients had microbiologically-documented infection. Initial peak PCT and CRP levels were not associated with treatment failure and 28-day mortality. However, PCT clearance (PCTc) and CRP (CRPc) clearance were significantly associated with treatment failure (p = 0.027 and p = 0.030, respectively) and marginally significant with 28-day mortality (p = 0.064 and p = 0.062, respectively). The AUC for prediction of treatment success was 0.71 (95% CI, 0.61–0.82) for PCTc and 0.71 (95% CI, 0.61–0.81) for CRPc. The AUC for survival prediction was 0.77 (95% CI, 0.66–0.88) for PCTc and 0.77 (95% CI, 0.67–0.88) for CRPc. Changes in PCT and CRP concentrations were associated with outcomes of critically ill septic patients. CRP may not be inferior to PCT in predicting outcome in these patients.     

Feasibility of Modified Surviving Sepsis Campaign Guidelines in a Resource-Restricted Setting Based on a Cohort Study of Severe S. Aureus Sepsis

Background

The Surviving Sepsis Campaign (SSC) guidelines describe best practice for the management of severe sepsis and septic shock in developed countries, but most deaths from sepsis occur where healthcare is not sufficiently resourced to implement them. Our objective was to define the feasibility and basis for modified guidelines in a resource-restricted setting.

Methods and Findings

We undertook a detailed assessment of sepsis management in a prospective cohort of patients with severe sepsis caused by a single pathogen in a 1,100-bed hospital in lower-middle income Thailand. We compared their management with the SSC guidelines to identify care bundles based on existing capabilities or additional activities that could be undertaken at zero or low cost. We identified 72 patients with severe sepsis or septic shock associated with S. aureus bacteraemia, 38 (53%) of who died within 28 days. One third of patients were treated in intensive care units (ICUs). Numerous interventions described by the SSC guidelines fell within existing capabilities, but their implementation was highly variable. Care available to patients on general wards covered the fundamental principles of sepsis management, including non-invasive patient monitoring, antimicrobial administration and intravenous fluid resuscitation. We described two additive care bundles, one for general wards and the second for ICUs, that if consistently performed would be predicted to improve outcome from severe sepsis.

Conclusion

It is feasible to implement modified sepsis guidelines that are scaled to resource availability, and that could save lives prior to the publication of international guidelines for developing countries.     

An Increase in Mean Platelet Volume from Baseline Is Associated with Mortality in Patients with Severe Sepsis or Septic Shock

Introduction

Mean platelet volume (MPV) is suggested as an index of inflammation, disease activity, and anti-inflammatory treatment efficacy in chronic inflammatory disorders; however, the effect of MPV on sepsis mortality remains unclear. Therefore, we investigated whether the change in MPV between hospital admission and 72 hours (ΔMPV_72h-adm) predicts 28-day mortality in severe sepsis and/or septic shock.

Methods

We prospectively enrolled 345 patients admitted to the emergency department (ED) who received standardized resuscitation (early goal-directed therapy) for severe sepsis and/or septic shock between November 2007 and December 2011. Changes in platelet indices, including ΔMPV_72h-adm, were compared between survivors and non-survivors by linear mixed model analysis. The prognostic value of ΔMPV_72h-adm for 28-day mortality was ascertained by Cox proportional hazards model analysis.

Results

Thirty-five (10.1%) patients died within 28 days after ED admission. MPV increased significantly during the first 72 hours in non-survivors (P = 0.001) and survivors (P < 0.001); however, the rate of MPV increase was significantly higher in non-survivors (P = 0.003). Nonetheless, the difference in the platelet decline rate over the first 72 hours did not differ significantly between groups (P = 0.360). In multivariate analysis, ΔMPV_72h-adm was an independent predictor of 28-day mortality, after adjusting for plausible confounders (hazard ratio, 1.44; 95% confidence interval, 1.01–2.06; P = 0.044).

Conclusions

An increase in MPV during the first 72 hours of hospitalization is an independent risk factor for adverse clinical outcomes. Therefore, continuous monitoring of MPV may be useful to stratify mortality risk in patients with severe sepsis and/or septic shock.     

Management of septic shock.

There have been important advances in the resuscitation of patients in septic shock in recent years. Survival can be improved by earlier recognition and therefore eradication of the sepsis combined with logical supportive measures. As with any acutely ill patient consultation with intensive care unit staff may be useful. Consultation with the intensive care unit does not necessarily imply the need for admission and mechanical ventilation; helpful advice may be forthcoming. Equally, referral to the intensive care unit does not mean an admission of failure but merely a recognition that additional skills and technical facilities are necessary for the patient''s survival.     

Prognostic and pathogenic role of CXC motif ligand 16 in sepsis

Chemokine CXC motif ligand 16 (CXCL16) is an important mediator that has been shown to participate in various human diseases. The role of CXCL16 in the immunopathology of sepsis remains unidentified. In this study, we found that human patients with sepsis had significantly higher soluble levels of serum CXCL16 than healthy volunteers on day of intensive care unit (ICU) admission. Soluble CXCL16 remained significantly up-regulated in the patients with sepsis, which correlated with disease severity. Furthermore, nonsurvivors displayed significantly higher admission levels of soluble CXCL16 compared with survivors of septic patients. Soluble CXCL16 levels revealed significant prognostic value for 28-day mortality, and CXCL16 was shown to be an independent predictor of 28-day mortality in the patients with sepsis. In a murine model of cecal ligation and puncture (CLP)-induced nonsevere sepsis, supplementation of recombinant CXCL16 protein could increase sepsis-induced mortality and tissue injury. Conversely, neutralizing CXCL16 by anti-CXCL16 monoclonal antibody could decrease mortality and tissue injury in CLP-induced severe sepsis. However, CXCL16 did not affect the ability of these mice to clear bacteria in CLP. Taken together, CXCL16 could be related to sepsis not only as a novel biomarker of prognosis, but also as a potential target for therapeutic intervention.     

Severity of sepsis alters the effects of superoxide anion inhibition in a rat sepsis model.

Previous analysis showed that selective inhibitors of five different host inflammatory mediators administered for sepsis, although beneficial with severe sepsis and high-control mortality rates, were ineffective or harmful with less severe sepsis. We hypothesized that severity of sepsis would also influence inhibition of superoxide anion, another inflammatory mediator. To test this, 6-h infusions of M40401, a selective SOD mimetic, or placebo were given to antibiotic-treated rats (n=547) starting 3 h after challenge with differing doses of intravenous Escherichia coli designed to produce low- or high-control mortality rates. There was a positive and significant (P=0.0008) relationship between the efficacy of M40401 on survival rate and control mortality rates. M40401 increased or decreased the log (odds ratio of survival) (means +/- SE), dependent on whether control mortality rates were greater or less than the median (66%) (+0.19 +/- 0.12 vs. -0.25 +/- 0.10, P=0.01). In a subset of animals examined (n=152) at 9 h after E. coli challenge, M40401 increased (mean effect +/- SE compared with control) mean arterial blood pressure (8 +/- 5 mmHg) and decreased platelets (-37 +/- 22 cells x 10(3)/ml) with high-control mortality rates but had opposing effects on each parameter (-3 +/- 3 mmHg and 28 +/- 19 cells x 10(3)/ml, respectively) with low rates (P < or = 0.05 for the differing effects of M40401 on each parameter with high- vs. low-control mortality rates). A metaregression analysis of published preclinical sepsis studies testing SOD preparations and SOD mimetics showed that most (16 of 18) had control mortality rates >66%. However, across experiments from published studies, these agents were less beneficial as control mortality rate decreased (P=0.03) in a relationship not altered (P=not significant) by other variables associated with septic challenge or regimen of treatment and which was similar, compared with experiments with M40401 (P=not significant). Thus, in these preclinical sepsis models, possibly related to divergent effects on vascular function, inhibition of superoxide anion improved survival with more severe sepsis and high-control mortality rates but was less effective or harmful with less severe sepsis. Extrapolated clinically, inhibition of superoxide anion may be most efficacious in septic patients with severe sepsis and a high risk of death.     

Acute Kidney Injury in Severe Sepsis and Septic Shock in Patients with and without Diabetes Mellitus: A Multicenter Study

IntroductionWhether diabetes mellitus increases the risk of acute kidney injury (AKI) during sepsis is controversial.ResultsFirst, we compared 451 patients with severe sepsis or septic shock and diabetes to 3,277 controls with severe sepsis or septic shock and without diabetes. Then, we compared 318 cases (with diabetes) to 746 matched controls (without diabetes). Diabetic patients did not have a higher frequency of AKI (hazard ratio [HR], 1.18; P = 0.05]) or RRT (HR, 1.09; P = 0.6). However, at discharge, diabetic patients with severe sepsis or septic shock who experienced acute kidney injury during the ICU stay and were discharged alive more often required RRT (9.5% vs. 4.8%; P = 0.02), had higher serum creatinine values (134 vs. 103 µmoL/L; P<0.001) and had less often recovered a creatinine level less than 1.25 fold the basal creatinine (41.1% vs. 60.5%; P<0.001).ConclusionsIn patients with severe sepsis or septic shock, diabetes is not associated with occurrence of AKI or need for RRT but is an independent risk factor for persistent renal dysfunction in patients who experience AKI during their ICU stay.