Relationship between glycaemia and length of hospital stay during an acute exacerbation of chronic obstructive pulmonary disease

Burt, Morton G.; Roberts, G. W.; Aguilar-Loza, Norma; Quinn, Stephen; Frith, Peter; Stranks, Stephen N

doi:10.1111/imj.12157

Cited by 21 publications

(22 citation statements)

References 22 publications

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“…Previous studies have shown that hyperglycemia during hospitalization is associated with poor outcomes in patients with COPD, which prolongs the length of stay and increases the risk of death in patients with acute exacerbated COPD19202122. However, in the present study, hyperglycemia did not have any significant predictive value for mortality in the fully adjusted survival analysis (P = 0.519).…”

Section: Discussioncontrasting

confidence: 87%

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The existence of bronchiectasis predicts worse prognosis in patients with COPD

Mao

et al. 2015

Sci Rep

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Bronchiectasis is prevalent in patients with COPD. The objective of this study was to assess the clinical characteristics and prognostic value of bronchiectasis in patients with COPD in China. Data from patients diagnosed with COPD at the Shanghai Pulmonary Hospital between January 2009 and December 2013 were retrospectively collected and analyzed. SPSS statistical software was used to analyze the data. Data from 896 patients with COPD were analyzed. Bronchiectasis was present in 311 patients. The isolation of pseudomonas aeruginosa (PA) from sputum was the variable most significantly associated with the presence of bronchiectasis in patients with COPD (hazard ratio (HR), 2.93; 95% confidence interval (CI), 1.35–6.37; P = 0.007). During follow-up (median of 21 months; interquartile range: 10-39 months), there were 75 deaths, of which 39 were in the bronchiectasis group. The presence of bronchiectasis (HR, 1.77; 95% CI, 1.02–3.08; P = 0.043) was associated with an increase in all-cause mortality in patients with COPD. These results suggest that bronchiectasis in patients with COPD was associated with the isolation of PA from the sputum. Bronchiectasis was an independent risk factor for all-cause mortality in patients with COPD.

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Section: Discussioncontrasting

confidence: 87%

“…Hemoglobin level and oxygen and carbon dioxide partial pressures (PO 2 and PCO 2 , respectively) were also assessed. Finally, blood glucose level was also collected because recent research has found this variable to be correlated with COPD mortality19202122. The detailed study procedure is shown in Fig.…”

Section: Methodsmentioning

confidence: 99%

The existence of bronchiectasis predicts worse prognosis in patients with COPD

Mao

et al. 2015

Sci Rep

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“…8 16 17 However, point-of-care glucometers are subject to greater analytical error than laboratory analysis of venous blood, which may reduce measurement precision. This is mitigated by the fact that, being less burdensome and costly, capillary glucose can be measured more frequently and thus better capture biological fluctuations.…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis of this is probably multifactorial, including effects from systemic corticosteroid and inhaled β-agonist therapy,10 11 hypoxia,12 acidosis,13 and stress-related increases in glucose-elevating hormones 1415 Elevated blood glucose concentration is associated with prolonged hospital stay and death, the risk of which increases by 7%–15% for each 1 mmol/L increment in blood glucose concentration,7 16 17 and with failure of non-invasive ventilation 18. Whether these associations are causal is unknown.…”

Section: Introductionmentioning

confidence: 99%

Metformin in severe exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial

Hitchings

Lai

Jones

et al. 2016

Thorax

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BackgroundSevere exacerbations of COPD are commonly associated with hyperglycaemia, which predicts adverse outcomes. Metformin is a well-established anti-hyperglycaemic agent in diabetes mellitus, possibly augmented with anti-inflammatory effects, but its effects in COPD are unknown. We investigated accelerated metformin therapy in severe COPD exacerbations, primarily to confirm or refute an anti-hyperglycaemic effect, and secondarily to explore its effects on inflammation and clinical outcome.MethodsThis was a multicentre, randomised, double-blind, placebo-controlled trial testing accelerated metformin therapy in non-diabetic patients, aged ≥35 years, hospitalised for COPD exacerbations. Participants were assigned in a 2:1 ratio to 1 month of metformin therapy, escalated rapidly to 2 g/day, or matched placebo. The primary end point was mean in-hospital blood glucose concentration. Secondary end points included the concentrations of fructosamine and C reactive protein (CRP), and scores on the COPD Assessment Test and Exacerbations of Chronic Pulmonary Disease Tool.Results52 participants (mean (±SD) age 67±9 years) were randomised (34 to metformin, 18 to placebo). All were included in the primary end point analysis. The mean blood glucose concentrations in the metformin and placebo groups were 7.1±0.9 and 8.0±3.3 mmol/L, respectively (difference −0.9 mmol/L, 95% CI −2.1 to +0.3; p=0.273). No significant between-group differences were observed on any of the secondary end points. Adverse reactions, particularly gastrointestinal effects, were more common in metformin-treated participants.ConclusionMetformin did not ameliorate elevations in blood glucose concentration among non-diabetic patients admitted to hospital for COPD exacerbations, and had no detectable effect on CRP or clinical outcomes.Trial registration numberISRCTN66148745 and NCT01247870.

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“…longer hospital stay and death) increasing by 15% for each 1-m M increment in blood glucose [11]. Moreover, it was also reported that the length of hospital stay after AECOPD increased by 10% for each 1-m M increase in mean glucose [40]. These findings suggest a potentially negative impact of the diabetic condition on AECOPD.…”

Section: The Impact Of Diabetes On Patients With Copdmentioning

confidence: 96%

Chronic Obstructive Pulmonary Disease and Diabetes Mellitus: A Systematic Review of the Literature

et al. 2015

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The objective of this systematic review was to discuss our current understanding of the complex relationship between chronic obstructive pulmonary disease (COPD) and type-2 diabetes mellitus (T2DM). We performed a systematic search of the literature related to both COPD and diabetes using PubMed. Relevant data connecting both diseases were compiled and discussed. Recent evidence suggests that diabetes can worsen the progression and prognosis of COPD; this may result from the direct effects of hyperglycemia on lung physiology, inflammation or susceptibility to bacterial infection. Conversely, it has also been suggested that COPD increases the risk of developing T2DM as a consequence of inflammatory processes and/or therapeutic side effects related to the use of high-dose corticosteroids. In conclusion, although there is evidence to support a connection between COPD and diabetes, additional research is needed to better understand these relationships and their possible implications.

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Relationship between glycaemia and length of hospital stay during an acute exacerbation of chronic obstructive pulmonary disease

Cited by 21 publications

References 22 publications

The existence of bronchiectasis predicts worse prognosis in patients with COPD

The existence of bronchiectasis predicts worse prognosis in patients with COPD

Metformin in severe exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial

Chronic Obstructive Pulmonary Disease and Diabetes Mellitus: A Systematic Review of the Literature

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