Objective:To investigate the clinical characteristics in older adult patients with sepsis and heart failure, and to analyze the influential factors of prognosis.Methods:Eighty-eight older adult patients with sepsis and heart failure who received treatment at Lishui Central Hospital from January 2020 to December 2022 were retrospectively included in the heart failure group. Eighty-eight older adult patients with sepsis, who did not have heart failure, were selected in a 1:1 ratio to form a non-heart failure group. Based on their survival status during hospitalization, the patients in the heart failure group were divided into two subgroups: the survival group and the death group. Logistic regression analysis was performed to identify the risk factors associated with the development of heart failure and adverse disease outcomes in older adult patients with sepsis.Results:There were no statistically significant differences in sex, smoking history, alcohol consumption history, history of hypertension, and history of diabetes between the heart failure group and the non-heart failure group (all P > 0.05). However, the proportion of patients aged 75 years or older in the heart failure group was 52.27% (46/88), which was significantly higher than the proportion in the non-heart failure group [34.09% (30/88), χ2 = 5.93, P < 0.05]. The proportion of patients with respiratory system infections in the heart failure group was 53.41% (47/88), which was significantly higher than the proportion in the non-heart failure group [29.55% (26/88), χ2 = 10.37, P < 0.05]. Logistic regression analysis showed that advanced age and respiratory system infections are independent risk factors for the development of heart failure in patients with sepsis. Among patients with sepsis and heart failure, 45 survived and 43 died, resulting in a mortality rate of 48.86%. The average age of patients in the death group was (76.27 ± 4.14) years, which was significantly higher than that in the survival group [(72.29 ± 4.06) years, t = 4.55, P < 0.05]. The brain natriuretic peptide level and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in the death group were (636.70 ± 70.29) pg/mL and (31.93 ± 3.08) points, respectively, both of which were significantly higher than those in the survival group [(552.80 ± 54.66) pg/mL, (27.06 ± 3.80) points, t = 6.27, 6.59, both P < 0.05]. The lactate clearance rate and serum albumin level in the death group were (13.63 ± 4.84)% and (26.09 ± 4.77) g/L, respectively, both of which were significantly lower than those in the survival group [(19.94 ± 5.07)%, (30.55 ± 5.17) g/L, t = 5.97, 4.20, both P < 0.05]. Logistic regression analysis showed that in patients with sepsis and heart failure, advanced age, elevated serum brain natriuretic peptide levels, and high APACHE II scores are risk factors for poor prognosis and death. A high lactate clearance rate at 24 hours and elevated serum albumin levels are protective factors for survival. Conclusion:Advanced age and respiratory system infections increase the risk of heart failure in patients with sepsis. Advanced age, elevated brain natriuretic peptide levels, and high APACHE II scores are associated with an increased risk of death in these patients. High lactate clearance rates and elevated serum albumin levels are indicative of a reduced risk of death in patients with sepsis.

Objective:To investigate the effect of programmed blood glucose management model on blood glucose control and prognosis in patients with sepsis and diabetes mellitus.Methods:Seventy-six patients with sepsis and diabetes mellitus who received treatment at the Fifth Hospital Affiliated to Wenzhou Medical University (Lishui Central Hospital) were included in this study. According to the implementation time of programmed blood glucose management model, the patients were divided into a routine group ( n = 37; receiving routine nursing between January 2021 and December 2022) and an experimental group ( n = 39, receiving routine nursing and programmed blood glucose management). Length of hospital stay, 28-day mortality rate, blood glucose control level (glycosylated hemoglobin level, blood glucose variability, incidence of hypoglycemia, fasting blood glucose level, and 2-hour postprandial glucose level), and health status (Medical Outcomes Study-36-Item Shot-Form Health Status Survey) as well as incidence of adverse events were compared between the two groups. Results:The length of hospital stay in the experimental group was (14.85 ± 2.77) days, which was significantly shorter than that in the routine group [(17.42 ± 3.24) days, t = 3.72, P < 0.001]. The 28-day mortality rate in the experimental group was 7.69% (3/39), which was significantly lower than that in the control group [24.32% (9/37), χ2 = 3.95, P = 0.047]. The level of glycated hemoglobin and blood glucose variability in the experimental group were 10.4 (8.5, 12.1) mmol/L and (31.54 ± 7.16)%, which were significantly lower than those in the routine group [12.8 (8.9, 15.3) mmol/L, (45.63 ± 12.19)%, Z = 6.88, P < 0.001; t = 6.18, P < 0.001]. There was no significant difference in the incidence of hypoglycemia between the experimental and routine groups [10.81% (4/37) vs. 5.13% (2/39), χ2 = 0.84, P = 0.358]. After the intervention, the experimental group had higher scores in various dimensions of the 36-Item Shot-Form Health Status Survey, including limitations [(72.21 ± 5.37) points], bodily pain [(82.98 ± 6.41) points], general health [(81.32 ± 6.23) points], and physical function [(71.43 ± 5.22) points] compared with the routine group [(68.39 ± 6.21) points, (78.35 ± 6.17) points, (74.50 ± 7.57) points, (65.57 ± 6.96) points, t = 2.87, P = 0.005; t = 3.20, P = 0.002; t = 4.29, P < 0.001; t = 4.16, P < 0.001]. There was no significant difference in the incidence of adverse events between the experimental and routine groups [10.26% (4/39) vs. 13.51% (5/37), χ2 = 0.19, P = 0.660]. Conclusion:Programmed blood glucose management model can improve blood glucose control level and prognosis of patients with sepsis and diabetes mellitus.