Hyperglycemia predicts death in pneumonia

Glucose Levels at Admission Predict Death in Pneumonia
Glucose Levels at Admission Predict Death in Pneumonia

HealthDay News --  Patients with elevated serum glucose levels on admission for community-acquired pneumonia have an increased risk for dying within 90 days, results from a large European cohort study indicate.

Compared with those whose serum glucose was normal on admission, patients with mild to moderate hyperglycemia (serum glucose 6 to 10.99 mmol/L) had a hazard ratio (HR) for 90-day mortality of 1.56 (95% CI 1.22 to 2.01; P<0.001), researchers reported in BMJ.

When patients' serum glucose concentrations were ≥14 mmol/L, the risk of dying at 3 months increased to an HR of 2.37 (95% CI 1.62 to 3.46, P<0.001).

"In our study, hyperglycemia was identified as an independent risk factor for increased risk of death from pneumonia," Philipp M. Lepper, MD, of the University Hospital of Saarland in Homburg, Germany, and colleagues wrote.

Results from previous studies regarding the link between high serum glucose and death from community-acquired pneumonia have been mixed. So Lepper and colleagues conducted a multicenter prospective cohort study among patients admitted to hospitals and private practices in Germany, Switzerland and Austria from 2003 to 2009.

A total of 6,891 patients diagnosed with community-acquired pneumonia were included in the German Community Acquired Pneumonia competence network (CAPNETZ) study -- the largest trial to date to examine this topic in detail, according to the researchers.

Patients without diabetes and normal glucose levels on admission had the lowest mortality after 90 days at 3%.

Patients without diabetes but with elevated glucose levels on admission had a 10% mortality rate, whereas diabetic patients had the highest (14%) mortality rate at three months, regardless of their glucose levels when admitted, the researchers wrote.

Although a nearly two-fold increased risk of dying was identified among the 16% of patients with preexisting diabetes (adjusted HR 1.88, P<0.001), serum glucose levels on admission in these patients did not significantly affect mortality risk (P=0.18 for interaction).

"Serum glucose levels on admission to hospital can predict death in patients with community-acquired pneumonia without preexisting diabetes," the researchers wrote. "Acute hyperglycemia may therefore identify patients in need of intensified care to reduce the risk of death from community-acquired pneumonia."

They suggested conducting oral glucose testing to diagnose overt diabetes and continued close glucose monitoring after discharge to prevent subacute or long-term complications.

"Large-scale trials are needed to define optimal serum glucose levels and to determine if a drug intervention is suitable," the researchers concluded.

Lepper PM. BMJ. 2012; 344:e3397.

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