Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease

Abstract

Background: Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD. Methods: Data were retrieved from electronic records for patients admitted with AECOPD with lower respiratory tract infection in 2001-2. The patients were grouped according to blood glucose quartile (group 1, ,6 mmol/l (n = 69); group 2, 6.0-6.9 mmol/l (n = 69); group 3, 7.0-8.9 mmol/l (n = 75); and group 4, .9.0 mmol/l (n = 71)). Results: The relative risk (RR) of death or long inpatient stay was significantly increased in group 3 (RR 1.46, 95% CI 1.05 to 2.02, p = 0.02) and group 4 (RR 1.97, 95% CI 1.33 to 2.92, p,0.0001) compared with group 1. For each 1 mmol/l increase in blood glucose the absolute risk of adverse outcomes increased by 15% (95% CI 4 to 27), p = 0.006. The risk of adverse outcomes increased with increasing hyperglycaemia independent of age, sex, a previous diagnosis of diabetes, and COPD severity. Isolation of multiple pathogens and Staphylococcus aureus from sputum also increased with increasing blood glucose. Conclusion: Increasing blood glucose concentrations are associated with adverse clinical outcomes in patients with AECOPD. Tight control of blood glucose reduces mortality in patients in intensive care or following myocardial infarction. A prospective study is now required to determine whether control of blood glucose can also improve outcomes from AECOPD.

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

“…The thesis of the protective potential of a higher body mass index in diabetic patients has been discussed by MCGHAN et al [32], but is still speculative. Another explanation model is that comorbidities may include unidentified treatment options which in diabetes therapy might lead to less blood sugar escalation caused by systemic corticosteroid therapy considered harmful in the studies of BAKER et al [34] and CHAKRABARTI et al [35].…”

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

“…Hyperglycemia during acute exacerbations of COPD requiring hospitalization is associated with poorer outcomes in terms of outcome of acute noninvasive ventilation [62], longer inpatient stay and in-hospital mortality [63]. These patients were also likely to have more than one species of bacteria grown from sputum during the admission, raising the possibility of a poorer immune response.…”

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

“…2 Observational studies have shown that hyperglycemia in hospitalized patients is associated with adverse outcomes including infectious complications, increased length of stay, and increased mortality. [2][3][4][5][6][7] Recent randomized controlled trials have demonstrated that aggressive treatment of inpatient hyperglycemia improves outcomes in surgical and medical intensive care units. 8,9 Based on the available data, the American Diabetes Association (ADA) now advocates good metabolic control, defined as preprandial glucose levels of 90 to 130 mg/dL and peak postprandial glucose levels <180 mg/dL in hospitalized non-intensive care unit (ICU) patients.…”