Elevated Admission Glucose and Mortality in Patients With Acute Pulmonary Embolism

Abstract

OBJECTIVEAlthough associated with adverse outcomes in other cardiopulmonary conditions, the prognostic value of elevated glucose in patients with acute pulmonary embolism (PE) is unknown. We sought to examine the association between glucose levels and mortality and hospital readmission rates for patients with PE.RESEARCH DESIGN AND METHODSWe evaluated 13,621 patient discharges with a primary diagnosis of PE from 185 acute care hospitals in Pennsylvania (from January 2000 to November 2002). Admission glucose levels were analyzed as a categorical variable (≤110, >110–140, >140–170, >170–240, and >240 mg/dL). The outcomes were 30-day all-cause mortality and hospital readmission. We used random-intercept logistic regression to assess the independent association between admission glucose levels and mortality and hospital readmission, adjusting for patient (age, sex, race, insurance, comorbid conditions, severity of illness, laboratory parameters, and thrombolysis) and hospital (region, size, and teaching status) factors.RESULTSElevated glucose (>110 mg/dL) was present in 8,666 (63.6%) patients. Patients with a glucose level ≤110, >110–140, >140–170, >170–240, and >240 mg/dL had a 30-day mortality of 5.6, 8.4, 12.0, 15.6, and 18.3%, respectively (P < 0.001). Compared with patients with a glucose level ≤110 mg/dL, the adjusted odds of dying were greater for patients with a glucose level >110–140 (odds ratio 1.19 [95% CI 1.00–1.42]), >140–170 (1.44 [1.17–1.77]), >170–240 (1.54 [1.26–1.90]), and >240 mg/dL (1.60 [1.26–2.03]), with no difference in the odds of hospital readmission.CONCLUSIONSIn patients with acute PE, elevated admission glucose is common and independently associated with short-term mortality.

Predictive value of biomarkers for the prognosis of acute pulmonary embolism in Japanese patients: Results of the Tokyo CCU Network registry

“…Furthermore, 30-day mortality increased with blood glucose levels. Interestingly, hyperglycemia has been reported as a prognostic factor for unfavorable short-term prognosis in patients admitted to the intensive care unit for pulmonary embolism [23] as well as for other diseases, including myocardial infarction, arrhythmia, unstable angina, heart failure, stroke, gastrointestinal bleeding, pneumonia, renal failure, and sepsis [24]. However, no conclusions regarding whether strict control of blood glucose levels improves prognoses for intensive care unit patients have been made [24].…”

Admission blood glucose predicts mortality and length of stay in patients admitted through the emergency department

“…Hyperglycaemia has been associated with a number of adverse outcomes in certain hospital populations, including patients with acute myocardial infarction, community‐acquired pneumonia, stroke, chronic obstructive pulmonary disease (COPD), trauma and pulmonary embolism . The effects of glycaemic control on clinical outcomes have been examined extensively in patients during critical illness .…”

Does intermittent pneumatic compression increase the risk of pulmonary embolism in deep venous thrombosis after joint surgery?

“…Movahed et al reported that 0.7% of patients with diabetes suffered pulmonary embolism, whereas only 0.5% of the controls suffered pulmonary embolism (odds ratio, 1.27; 95% confidence interval, 1.19-1.35; P < 0.001) [28]. In addition, a large retrospective cohort study showed that elevated glucose levels were present in the majority of patients with acute pulmonary embolism and were independently associated with 30-day mortality [29]. The reason for the close connection between diabetes mellitus and pulmonary embolism is that hyperglycaemia contributes to coagulation activation and hypofibrinolysis, resulting in a prothrombotic state [30].…”