Is blood glucose on admission a predictor of mortality in adult acute pneumonia?

Foltran, Francesca; Gregori, Darío; Caropreso, A; Pagano, Eva; Bruno, Alberto

doi:10.1111/crj.12003

Cited by 12 publications

(4 citation statements)

References 16 publications

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“…The study by L epper et al was a prospective study, where the patients were younger and one-third were not hospitalised. Despite differences in design and population, our study confirms this and other previous studies in showing that elevated blood glucose in patients without DM may be associated with severe outcome and mortality [9, 10, 18]. …”

Section: Discussionsupporting

confidence: 90%

“…Diabetes was associated with prolonged LOS and LOIVAB, but only LOS remained significant after adjusting for confounders. Hyperglycaemia has been associated with excess mortality in patients admitted to ICUs [17] and in CAP patients with hyperglycaemia [9, 10, 18], although the literature is inconsistent [13, 14]. In 2012, L epper et al [10] found, in a large prospective multicentre cohort study of CAP, that hyperglycaemia is strongly associated with 90 day mortality in patients without DM.…”

Section: Discussionmentioning

confidence: 99%

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The impact of blood glucose on community-acquired pneumonia: a retrospective cohort study

et al. 2017

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Hyperglycaemia is common in patients with community-acquired pneumonia (CAP) and is a predictor of severe outcomes. Data are scarce regarding whether this association is affected by diabetes mellitus (DM) and also regarding its importance for severe outcomes in hospital. We determined the impact of blood glucose on severe outcomes of CAP in hospital.We studied 1318 adult CAP patients hospitalised at three Danish hospitals. The association between blood glucose and DM status and severe clinical outcome (admission to an intensive care unit (ICU) and/or in-hospital mortality) was assessed by logistic regression. Models were adjusted for CURB-65 score and comorbidities.12% of patients had DM. In patients without DM an increase in admission blood glucose was associated with risk for ICU admittance (OR 1.25, 95% CI 1.13–1.39), but not significantly associated with in-hospital mortality (OR 1.10, 95% CI 0.99–1.23). In patients with DM an increase in admission blood glucose was not associated with ICU admittance (OR 1.05, 95% CI 1.00–1.12) or in-hospital mortality (OR 1.05, 95% CI 0.99–1.12).An increase in admission blood glucose (only in patients without DM) was associated with a higher risk for ICU admittance and a trend towards higher in-hospital mortality. DM was not associated with a more severe outcome of CAP.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

The impact of blood glucose on community-acquired pneumonia: a retrospective cohort study

et al. 2017

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“…Furthermore, it has been reported that elevated ABG level is associated with poor outcomes in patients with various acute conditions including stroke, myocardial infarction, heart failure, surgery, trauma, pneumonia, and pulmonary embolism [ 24 25 26 27 28 29 30 ]. Likewise, the recent study demonstrated that there was a significant association between ABG and short and long-term mortality in patients without DM, but not in patients with DM, hospitalized for UTI [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

The Predictive Value of Glycated Hemoglobin and Albumin for the Clinical Course Following Hospitalization of Patients with Febrile Urinary Tract Infection

et al. 2018

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BackgroundDiabetes is considered a risk factor for acquisition of febrile urinary tract infection (f-UTI), but information on the association of diabetes with subsequent course of the disease is lacking. Thus, we investigated the clinical variables including diabetic status which determined the clinical course in patients with community-acquired f-UTI.Materials and MethodsPatients hospitalized consecutively for f-UTI between February 2016 and January 2018 were used for this single center study. The routine laboratory tests including blood glucose and glycated hemoglobin (HbA1c) were done and empiric treatment with parenteral antibiotics was commenced on admission. The clinical course such as duration of fever (DOF) and length of hospital stay (LOS) were compared among groups classified by the clinical variables.ResultsAmong the101 patients admitted for f-UTI, 15 patients with diabetes (14.9%) experienced significantly longer febrile period and hospitalization compared to those with hyperglycemia (n = 18, 17.8%) or those without diabetes and hyperglycemia (n = 68, 67.3%). Of the laboratory parameters tested on admission and several clinical factors, the presence of diabetes and risk factors for severe complicated infection (hydronephrosis, urosepsis, and disseminated intravascular coagulopathy) as well as HbA1c and albumin were identified as predictors for LOS by univariate analysis, whereas none of the variables failed to predict DOF. In the subsequent multivariate analysis, HbA1c levels and albumin levels were isolated as independent predictors of LOS.ConclusionPatients with higher HbA1c and lower albumin levels required the longest period of hospitalization. Thus, an evaluation of diabetic and nutritional status on admission will be feasible to foretell the clinical course and better manage the subset of patients at risk of prolonged hospitalization.

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“…In patients with CAP (Table 5 ) , hypoglycemia [ 112 ] and hyperglycemia are associated with a higher rate of in-hospital mortality [ 112 , 113 ] and in-hospital complications [ 113 ]. Furthermore, hyperglycemia is a predictor of death at 28 and 90 days after admission to hospital in patients with CAP and no pre-existing diabetes [ 114 ].…”

Section: Promising Metabolic Biomarkers For Prediction Of All-cause Mmentioning

confidence: 99%

Systematic review regarding metabolic profiling for improved pathophysiological understanding of disease and outcome prediction in respiratory infections

et al. 2015

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Metabolic profiling through targeted quantification of a predefined subset of metabolites, performed by mass spectrometric analytical techniques, allows detailed investigation of biological pathways and thus may provide information about the interaction of different organic systems, ultimately improving understanding of disease risk and prognosis in a variety of diseases. Early risk assessment, in turn, may improve patient management in regard to cite-of-care decisions and treatment modalities. Within this review, we focus on the potential of metabolic profiling to improve our pathophysiological understanding of disease and management of patients. We focus thereby on lower respiratory tract infections (LRTI) including community-acquired pneumonia (CAP) and chronic obstructive pulmonary disease (COPD), an important disease responsible for high mortality, morbidity and costs worldwide. Observational data from numerous clinical and experimental studies have provided convincing data linking metabolic blood biomarkers such as lactate, glucose or cortisol to patient outcomes. Also, identified through metabolomic studies, novel innovative metabolic markers such as steroid hormones, biogenic amines, members of the oxidative status, sphingo- and glycerophospholipids, and trimethylamine-N-oxide (TMAO) have shown promising results. Since many uncertainties remain in predicting mortality in these patients, further prospective and retrospective observational studies are needed to uncover metabolic pathways responsible for mortality associated with LRTI. Improved understanding of outcome-specific metabolite signatures in LRTIs may optimize patient management strategies, provide potential new targets for future individual therapy, and thereby improve patients’ chances for survival.

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Is blood glucose on admission a predictor of mortality in adult acute pneumonia?

Abstract: Our observations suggest that in non-intensive care patients, hypoglycaemia, as hyperglycaemia, is associated with in-hospital mortality.

Cited by 12 publications

References 16 publications

The impact of blood glucose on community-acquired pneumonia: a retrospective cohort study

The impact of blood glucose on community-acquired pneumonia: a retrospective cohort study

The Predictive Value of Glycated Hemoglobin and Albumin for the Clinical Course Following Hospitalization of Patients with Febrile Urinary Tract Infection

Systematic review regarding metabolic profiling for improved pathophysiological understanding of disease and outcome prediction in respiratory infections

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