To Validate REMS Score in Patients with Diabetes and Sepsis-A Study in Rural Tumkur.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2019, Vol 4, Issue 3
Abstract
Introduction :Hyperglycaemia is a commonly encountered complication in critically ill patients in the intensive care setting. It is associated with increased mortality and poor outcome in hospitalized patients. It is an accepted opinion that diabetes worsens prognosis of infection, particularly sepsis. With diabetes assuming alarmingly epidemic proportions in India, a study to evaluate the predictive ability of REMS (Rapid Emergency Medicine Scoring) in patients with diabetes & sepsis is attempted to gauge the impact on mortality and morbidity (length of hospital stay) so as to evolve a consensus on early and aggressive glycaemic control & treatment. Aim & Objectives : To assess the predictive ability of REMS score for hospital mortality and length of stay in patients with type 2 diabetes mellitus and sepsis. Materials & Methods : This was a prospective, observational study involving a total of 114 patients of both sexes, all cases of Sepsis with type 2 Diabetes Mellitus admitted in the emergency wards and the Intensive care units. To estimate the severity of sepsis, REMS (rapid emergency medicine score) scoring on the day of admission was tabulated and subsequently, the hospital mortality & length of stay (LOS), the outcome measures were calculated. Results • 114 patients were recruited for this study. The maximum number of patients was observed in age group between 61 to 70 years (24.6%). The mean age was 58.56 years (SD 14.51). • Out of the total 114 patients, 74 were male patients (64.9%) & 40 were female patients (35.1%). • Hyperglycemia with reference to elevated Random Blood Sugar according to the 2010 ADA criteria was seen in 80(70.2%) of the patients that were recruited for the study out of which 25 were females (62.5%) and 55 were males (74.3%). • 35% of the total cases had severe uncontrolled Diabetes mellitus. • Oral drugs are reported to be the preferred mode of treatment with 93 out of the 114 patients reporting use of the same. • Death was observed in 9 patients in which 6 were female and 3 were male. • Maximum number of deaths were seen in the group having HBA1c >11 & range of 8.1 - 9.4, where 3 deaths were recorded. • Those with HbA1c 8.1-9.4% and >11% demonstrated higher mortality rate than those with HbA1c 6.5-8% and 9.5-11%. • The Mean ± S.D values of length of hospital stay(LOS) was approximately 13.53 ± 10.39 days in survived diabetic patients which was statistically higher than those who died (P < 0.002). • Patients who survived had significantly lower admission REM scores (5.94) than those who died (P < 0.001). • REM scores were shown to be independent predictor of mortality in the same analysis. • A multivariate analysis for hospital LOS has shown that HbA1c, REM score & age were not independently associated with longer hospitalization. Conclusion: REM scores were shown to be independent predictor of mortality in the same analysis while HbA1c, REM score & age were not independently associated with longer hospitalization (Length of Stay).
Authors and Affiliations
Dr. Nishath Chida
Keywords
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