Secondary Analysis of Fluids and Catheters Treatment Trial (FACTT) data reveal poor clinical outcomes in acute respiratory distress syndrome patients with diabetes

• Published in: Respiratory medicine 2024-03, Vol.223, p.107540, Article 107540
• Main Authors: Alanazi, Abdulaziz H., Almuntashiri, Sultan, Sikora, Andrea, Zhang, Duo, Somanath, Payaningal R.
• Format: Article
• Language: English
• Subjects: Acute lung injury; Acute respiratory distress syndrome; Catheters; Chemokines; Cytokine; Cytokines; Diabetes Mellitus; Humans; Mortality; Respiratory Distress Syndrome - therapy
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2024.107540

Conflicting reports exist about the link between diabetes mellitus (DM) and acute respiratory distress syndrome (ARDS). Our study examines the impact of pre-existing DM on ARDS patients within the Fluid and Catheter Treatment Trial (FACTT). Conducting a secondary analysis of FACTT data, we incorporated 967 participants with identified DM status (173 with DM, 794 without DM) and examined outcomes like 90-day mortality, hospital and ICU stays, and ventilator days until unassisted breathing. The primary outcome of hospital mortality at day 90 was evaluated through logistic regression using IBM SPSS software. Additionally, we assessed plasma cytokines and chemokines utilizing a human magnetic bead-based multiplex assay. Patients with pre-existing DM exhibited a lower survival rate compared to non-DM patients (61.3 vs. 72.3 %, p = 0.006). Subjects with DM experienced significantly longer hospital lengths of stay (24.5 vs. 19.7 days; p = 0.008) and prolonged ICU stays (14.8 vs. 12.4 days; p = 0.029). No significant difference was found in ventilator days until unassisted breathing between the two groups (11.7 vs. 10; p = 0.1). Cytokine/chemokine analyses indicated a non-significant trend toward heightened levels of cytokines (TNF-α, IL-10, and IL-6) and chemokines (CRP, MCP-1) in DM patients compared to non-DM on both days 0 and 1. Notably, lipopolysaccharide‐binding protein (LBP) exhibited significantly higher levels in DM compared to non-DM individuals. ARDS patients with DM suffered worse clinical outcomes compared to non-DM patients, indicating that DM may negatively affect the respiratory functions in these subjects. Further comprehensive clinical and pre-clinical studies will strengthen this relationship. •A link between diabetes mellitus and acute lung injury are conflicting.•Diabetic patients with lung injury had a lower survival rate than non-diabetics.•Diabetic lung injury patients had extended hospital and intensive care unit stays.•Diabetes may negatively affect pulmonary function in lung injury patients.•Diabetic lung injury patients had worsened outcomes compared to non-diabetic.