Influence of diabetes mellitus on the characteristics and outcome of common fevers in abbassia fever hospital, Cairo, Egypt

Abstract EN

Background : Infectious morbidities are common with diabetics being susceptible to infection for various causes.

Little information is available on the influence of diabetes and glycemic control on the course and outcome of common infectious diseases.

Objective : The aim of the present work is to study the possible role of diabetes and the degree of diabetic control on the prognosis of patients with fever.

Also, study the prognostic value of serum interleukin-6 (IL-6) and phagocytic function estimation in diabetic patients suffering from fever and if interleukin-6 could be used as an indicator of mortality in these patients.

Study Design : This study was conducted on fifty patients with type 2 diabetes mellitus.

Patients were divided into two groups in comparison to 10 healthy subjects with matched age and sex as controls.

Group (I): included fifteen diabetic patients with fever and coma.

Group (II): included thirty-five diabetic patients with fever and infection.

The infection was either systemic (23 cases) or local (12 cases).

All individuals of the study were subjected for: Careful history taking and thorough clinical examination, complete blood picture including erythrocyte sedimentation rate, septic workup, glycated haemoglobin as a marker of glycemic control, phagocytic function and determination of IL-6 serum level twice at the first and the fifth days of admission to the hospital.

Results : Interleukin-6 was significantly elevated in group II (patients with infection) than in group 1 both in the day of admission (7.66+4.09 and 2.01 ± 0.61 ng / ml), and in the fifth day (2.057 ± 3.56 and 0.96 ± 0.46 ng / ml).

When group (I) was divided according to mortality into survivors and non-survivors we found that the patients who died were having longer duration of diabetes (p < 0.05) and significantly higher levels of glycated haemoglobin (p <0.01).

An interesting finding was that IL-6 at the day of admission was significantly higher (p < 0.01) in the patients who died, when compared to patients who survived (2.48 ± 0.61 and I.70 ± 0.38 ng / ml).

comparative study of group II divided into systemic and local infection showed that, there was no significant difference in the level of IL-6 between the two groups at the day of admission (p > 0.05).

However, IL-6 was significantly elevated (p < 0.05) in the group of patients with systemic infection at the fifth day compared to patients with local infection (3.27+ 4.09 and 1.02+ 0.89 ng/ml).

When the patients of group II were divided according to mortality into survivors and non survivors, again the glycated haemoglobin was significantly higher in the patients who died (p < 0.01).

Interestingly, IL-6 was significantly elevated (p < 0.01) in the group of patients who died compared to survivors both in the day of admission (I3.38 ± 2.11 and 5.97± 2.76 ng / ml) as well as in the fifth day (I0.46 ± .1.52 and 1.10+ 0.76 ng / ml).

The only significant difference in phagocytic function was found when we compared the two groups (group I & II) to the control group (p < 0.01).

Conclusions : There is an association between poor glycemic control and a fatal outcome of infectious diseases in diabetic patients.

Serum levels of IL-6 appear to be good predictor of bacteremia or infection in diabetic patients.

Also, serial IL-6 measurements could be used to detect prognosis in diabetic patients with infection.

High IL-6 serum level on admission seem to assist prognosis by indicating if patients need closer observation and ICU monitoring.

Rapidly decreasing IL-6 level could indicate a very good chance for survival.

Phagocytic function could not be used as a marker for prognosis and mortality in diabetic patients suffering from infection.