Better Acute Glycemic Control During Pulmonary Exacerbations Is Associated with Longer Time to Next Admission in Pediatric Cystic Fibrosis

Abstract

RATIONALE: Whether short-term glycemic control affects recovery during acute pulmonary exacerbations in CF is unclear. We previously reported that patients with CFRD and better glycemic control have better FEV1 recovery during acute exacerbations. We hypothesized that better glycemic control would be associated with longer time until next exacerbation. METHODS: We used previously abstracted EHR data for all patients with CF ages 6-21 years hospitalized for pulmonary exacerbations at our pediatric CF Center for 2010-2016. Our main outcome was time to the next admission for pulmonary exacerbation. Glycemic control was defined by the area under curve (AUC) from all inpatient meter blood glucoses. Data were analyzed using multiple-event adjusted survival analysis. The basic model was adjusted for age, sex, and FEV1 at admission; the full model additionally included FEV1 recovery until discharge, CFRD status, BMI, presence of gastrostomy tube, F508del genotype, sputum MRSA colonization, and acute prednisone dosing. RESULTS: Poor glycemic control (AUC above the median) was associated with shorter time to next hospitalization in the basic model (HR=1.76 [95%CI=1.02-3.05], p=0.042; see Figure ) and the fully adjusted model (HR=2.05 [1.15-3.66], p=0.016). This was largely driven by patients who completed IV antibiotic treatment at home (HR=3.4 [1.05-10.85], p=0.04). Among patients who completed treatment in the hospital, other characteristics associated with 'survival' time to the next hospitalization included the presence of a gastrostomy tube (HR=4.1 [1.6-10.6], p=0.004), sputum MRSA (HR=2.2 [1.1-4.7], p=0.035), older age at admission (HR=1.1 per each year of age [1.002-1.2], p=0.044) and female sex (HR=1.98 [0.99-4.03], p=0.059). Additionally, among patients who completed treatment at home, receiving acute prednisone was associated with a small but significant protective effect (HR=0.98 [0.95-0.99], p=0.044). CONCLUSIONS: In CF patients hospitalized for a pulmonary exacerbation, poor glycemic control is associated with shorter time to the next hospital admission, independent of admission FEV1, FEV1 improvement during the index admission, CFRD status, or other clinical characteristics. If confirmed in other cohorts, this would further support aiming for normal glycemic levels during CF exacerbations. Patients with poor glycemic control may benefit from completing antibiotic treatment in the hospital.