Association of Hypoglycemia With Mortality for Subjects Hospitalized With Pneumonia

Abstract

Background Prior research has shown that hypoglycemia is associated with worse outcomes for the elderly, in sepsis, and in children with pneumonia. The purpose of this study was to examine whether hypoglycemia (< 70 mg/dL) is associated with increased 30-day mortality, after adjusting for potential confounders, for adults hospitalized with pneumonia. Methods A retrospective cohort study conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of, and had a chest x-ray consistent with, community-acquired pneumonia. Our primary analysis was a multivariable logistic regression with the dependent variable of 30-day mortality with independent variable of hypoglycemia, diabetes, severity of illness utilizing the Pneumonia Severity Index, and pneumonia-related processes of care. Results Data were abstracted on 787 subjects at the two hospitals. Mortality was 8.1% at 30-days. At presentation, 55% of subjects were low risk, 33% were moderate risk, and 12% were high risk. In our cohort 2.8% (n=22) had hypoglycemia at presentation. Unadjusted mortality for those who were hypoglycemic was 27.3% vs. 8.6% for those who were not (p=0.0003). In the multivariable analysis, hypoglycemia (odds ratio 4.1, 95% confidence interval 1.4–11.7) was significantly associated with 30-day mortality. Conclusions After adjusting for severity of illness and other potential confounders hypoglycemia is significantly associated with 30-day mortality for patients hospitalized with pneumonia. Patients with hypoglycemia should be placed in closely monitored settings even when by pneumonia specific risk systems they would normally be discharged.

Hypoglycemia, With or Without Insulin Therapy, Is Associated With Increased Mortality Among Hospitalized Patients

“…Most of these hypoglycemic episodes were treatment related, but spontaneous hypoglycemia is also known to be frequent (1). Hypoglycemia is associated with increased mortality (2–6). However, a cause and effect relationship between hypoglycemia and mortality has not been established (5).…”

A.S.P.E.N. Clinical Guidelines

“…25,38,39,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] Hypoglycemia could be partly responsible for the adverse effects noted with intensive insulin therapy, including mortality. 25 A large retrospective analysis of hypoglycemia in ICUs showed a stepwise and significant increase in mortality with increasingly severe hypoglycemia.…”

A scoring system to predict in-hospital death in oldest-old patients with infections in Taiwan

“…Furthermore, functional status prior to hospitalization had an even greater impact than comorbidities, 8 and it also had an influence after discharge. On the other hand, some studies related to the prediction of mortality in infection or sepsis have found that many laboratory variables are linked to an adverse prognosis, such as thrombocytopenia and thrombocytosis, 9 abnormal WBC count with increased band form percentage, 12,21 low cholesterol and albumin levels, 10,11 abnormal glucose level, 12,16,17 and high values of blood urea nitrogen, creatinine, and total bilirubin. 12,13 Nevertheless, those hospital-based surveys were only applicable to the general population and usually specific to one kind of infection or sepsis.…”

“…8 As to infection-related deaths, unstable vital signs, preexisting terminal illness, and abnormal platelet count have been reported to increase the risk of mortality. 5,9 Several studies have also reported that age, comorbidity, nutrition status, the number of organ dysfunctions, 10e15 and abnormal glucose level 16,17 are the most important predictors for hospital mortality in patients with infection or sepsis; however, these studies were not geriatric specific.…”