Effect of hyperglycaemia on inflammatory and stress responses and clinical outcome of pneumonia in non-critical-care inpatients: results from an observational cohort study

Abstract

Aims/hypothesis Despite the condition's high prevalence, the influence of hyperglycaemia on clinical outcomes in noncritical-care inpatients with infections remains ill defined. In this study, we analysed associations of glucose levels at admission and during initial inpatient treatment with the inflammatory response and clinical outcome in communityacquired pneumonia (CAP) patients. Methods This secondary observational analysis included 880 confirmed CAP patients. We used severity-adjusted multivariate regression models to investigate associations of initial and 96 h mean glucose levels with serially measured biomarker levels over 7 days (C-reactive protein [CRP], procalcitonin, white blood cell count [WBC], pro-adrenomedullin [ProADM]) and adverse clinical course (death and intensivecare unit admission). Results In the 724 non-diabetic patients (82.3% of the study population), moderate or severe hyperglycaemia (glucose 6-11 mmol/l and >11 mmol/l, respectively) was associated with increased risk for adverse clinical course (adjusted OR [95% CI] 1.4 [0.8, 2.4] and 3.0 [1.1, 8.0], respectively) and with higher CRP, WBC and ProADM levels over 7 days (p <0.05, ANOVA, all days). In diabetic patients (n =156), no similar associations were found for initial hyperglycaemia, although mean 96 h glucose levels ≥9 mmol/l were associated with adverse clinical course (adjusted OR 5.4 [1.1, 25.8]; p =0.03). No effect modification by insulin treatment was detected (interaction terms p >0.2 for all analyses). Conclusions/interpretation Initial hyperglycaemia in nondiabetic CAP patients, and prolonged hyperglycaemia in diabetic or non-diabetic CAP patients, are associated with a more pronounced inflammatory response and CAP-related adverse clinical outcome. Optimal glucose targets for insulin treatment of hyperglycaemia in non-critical-care settings should be defined.

The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study

“…We found similar effects across different medical diagnoses in our heterogeneous cohort. In particular, previous studies have found similar results in acute infections and cardiovascular disease . This suggests that the association between admission hyperglycaemia and adverse outcome in people without diabetes might be independent of the underlying diagnosis.…”

“…In addition to fact that people with diabetes and hyperglycaemia were not at increased risk of mortality in our study, there was also no association between initial blood glucose levels from people with diabetes and inflammatory biomarkers in another trial . This may be explained by insulin‐induced suppression of nuclear factor kappa‐light‐chain‐enhancer of activated B‐cells (NF‐kB), which modulates expression of pro‐inflammatory cytokines .…”

The prevalence of hyperglycaemia and its relationship with mortality, readmissions and length of stay in an older acute surgical population: a multicentre study

“…This association has been studied in the context of myocardial infarction, with significantly higher mortality rates reported among hyperglycaemic patients (8.4% vs 2.4%, p<0.001) 7. Similar findings have also been described, for patients with acute coronary syndrome,8 pneumonia9 and stroke 10. In addition, admission hyperglycaemia is associated with other poor outcomes, including increased length of hospital stay, hospital readmission and increased risk of infection 11 12…”

An Elevated Glycemic Gap is Associated with Adverse Outcomes in Diabetic Patients with Acute Myocardial Infarction

“…In non-diabetic or mixed populations, elevated admission glucose levels are common in patients with AMI and are strongly associated with an increased risk of poorer outcomes and mortality232. Acute and mean hyperglycemia during hospitalization is associated with adverse clinical outcomes2333435. Elevated admission hyperglycemia was associated with in-hospital mortality, a lower myocardial salvage index and composite MACEs in acute ST-segment elevation myocardial infarction (STEMI) patients3637383940.…”