Hyperglycemia in diabetics and non-diabetics: Effect on the risk for and severity of pneumococcal pneumonia

Rueda, Adriana M.; Ormond, Mandy; Gore, Meghana; Matloobi, Mahsa; Giordano, Thomas P.; Musher, Daniel M.

doi:10.1016/j.jinf.2009.12.003

Cited by 49 publications

(47 citation statements)

References 30 publications

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“…Therefore, the results of Kornum et al (11) are difficult to interpret. Rueda et al (36) reported that, in their study of nondiabetic patients admitted with pneumococcal pneumonia, there was a strong association of the severity of pneumonia and mortality with the admission serum glucose level, whereas, in diabetic patients, the severity of pneumonia and mortality was not related to the degree of hyperglycemia on admission. Falguera et al (12) prospectively studied the outcomes of 106 diabetic patients from among 660 consecutive cases of CAP and showed that the presence of multilobar infiltrates and the simultaneous occurence of comorbidities were independently associated with mortality among the 106 diabetic patients.…”

Section: Discussionmentioning

confidence: 97%

“…Our results are consistent with the findings of these studies in that the plasma glucose level on admission was not found to be associated with pneumonia-related mortality among the diabetic patients admitted with pneumonia. In diabetic patients, the height of the plasma glucose level on admission may be more closely related to the underlying state of diabetic control and cannot be specifically linked to extreme cytokine release (36). Patients with diabetes may in part be protected from acute glucose toxicity (37,38).…”

Section: Discussionmentioning

confidence: 99%

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Association of Hyperglycemia on Admission and During Hospitalization with Mortality in Diabetic Patients Admitted for Pneumonia

et al. 2013

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Objective Information available on the clinical features and outcomes of pneumonia in diabetic patients is limited. There are no data on the association between glycemic control during hospitalization and mortality in this population. The objective of this study is to examine whether the presence of hyperglycemia on admission and during hospitalization is associated with mortality in diabetic patients admitted to the hospital for pneumonia. Methods This study is a retrospective observational cohort study of diabetic adults hospitalized for the first time for pneumonia between 2005 and 2011 in a 358-bed community hospital. Univariate and multivariate analyses were performed for 30-day all-cause hospital mortality adjusted for sex, age, type of pneumonia (community-acquired pneumonia or nursing and health care-associated pneumonia), severity of pneumonia according to the A-DROP score and various comorbidities in consideration of the serum glucose and hemoglobin A1c levels on admission and the mean plasma glucose level during hospitalization. Results Of the 1,499 pneumonia patients evaluated, 185 (12.3%) (mean age 75 years) had diabetes mellitus. Fourteen (7.6%) of the 185 diabetic patients died within 30 days after admission. According to the univariate analysis, 30-day mortality was significantly associated with the A-DROP score (p<0.0001), the admission glucose level (p=0.01) and the mean plasma glucose level during hospitalization (p<0.0001). Even after adjusting for factors related to the severity of pneumonia, the mean plasma glucose level during hospitalization remained significantly associated with 30-day mortality (p=0.004). Conclusion Hyperglycemia determined according to the mean plasma glucose level during hospitalization is independently associated with 30-day all-cause hospital mortality in diabetic patients admitted for pneumonia.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Association of Hyperglycemia on Admission and During Hospitalization with Mortality in Diabetic Patients Admitted for Pneumonia

et al. 2013

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“…In pneumonia, a newly detected hyperglycaemia among patients without diabetes seems to increase the short-term mortality rate more than hyperglycaemia among patients with diabetes 13. The impact of new, pneumonia-associated hyperglycaemia on long-term mortality has not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Long-term mortality after community-acquired pneumonia—impacts of diabetes and newly discovered hyperglycaemia: a prospective, observational cohort study

et al. 2014

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ObjectivesCommunity-acquired pneumonia is associated with a significant long-term mortality after initial recovery. It has been acknowledged that additional research is urgently needed to examine the contributors to this long-term mortality. The objective of the present study was to assess whether diabetes or newly discovered hyperglycaemia during pneumonia affects long-term mortality.DesignA prospective, observational cohort study.SettingA single secondary centre in eastern Finland.Participants153 consecutive hospitalised patients who survived at least 30 days after mild-to-moderate community-acquired pneumonia.InterventionsPlasma glucose levels were recorded seven times during the first day on the ward. Several possible confounders were also recorded. The surveillance status and causes of death were recorded after median of 5 years and 11 months.ResultsIn multivariate Cox regression analysis, a previous diagnosis of diabetes among the whole population (adjusted HR 2.84 (1.35–5.99)) and new postprandial hyperglycaemia among the non-diabetic population (adjusted HR 2.56 (1.04–6.32)) showed independent associations with late mortality. New fasting hyperglycaemia was not an independent predictor. The mortality rates at the end of follow-up were 54%, 37% and 10% among patients with diabetes, patients without diabetes with new postprandial hyperglycaemia and patients without diabetes without postprandial hyperglycaemia, respectively (p<0.001). The underlying causes of death roughly mirrored those in the Finnish general population with a slight excess in mortality due to chronic respiratory diseases. Pneumonia was the immediate cause of death in just 8% of all late deaths.ConclusionsA previous diagnosis of diabetes and newly discovered postprandial hyperglycaemia increase the risk of death for several years after community-acquired pneumonia. As the knowledge about patient subgroups with an increased late mortality risk is gradually gathering, more studies are needed to evaluate the possible postpneumonia interventions to reduce late mortality.

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“…DIO mice have been shown to exhibit greater renal bacterial burdens in a model of S. aureus -induced sepsis and higher oral bacterial counts following P. gingivalus infection [43]. Diabetes, a common comorbidity of obesity, is a well-known risk factor for pneumococcal infections, and poor glucose control in diabetes is known to increase the risk of pneumococcal pneumonia [44], [45]. Hyperglycemia in type II diabetes is known to compromise host defense against cutaneous infections by impairing wound healing, antimicrobial peptide (LL-37)(cathelicidin) production, and epithelial cell proliferation following tissue injury [15], [46], [47].…”

Section: Discussionmentioning

confidence: 99%

No Impairment in Host Defense against Streptococcus pneumoniae in Obese CPEfat/fat Mice

et al. 2014

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In the US and globally, dramatic increases in the prevalence of adult and childhood obesity have been reported during the last 30 years. In addition to cardiovascular disease, type II diabetes, and liver disease, obesity has recently been recognized as an important risk factor for influenza pneumonia. During the influenza pandemic of 2009, obese individuals experienced a greater severity of illness from the H1N1 virus. In addition, obese mice have also been shown to exhibit increased lethality and aberrant pulmonary inflammatory responses following influenza infection. In contrast to influenza, the impact of obesity on bacterial pneumonia in human patients is controversial. In this report, we compared the responses of lean WT and obese CPEfat/fat mice following an intratracheal infection with Streptococcus pneumoniae, the leading cause of community-acquired pneumonia. At 16 weeks of age, CPEfat/fat mice develop severe obesity, hyperglycemia, elevated serum triglycerides and leptin, and increased blood neutrophil counts. There were no differences between lean WT and obese CPEfat/fat mice in survival or lung and spleen bacterial burdens following intratracheal infection with S. pneumoniae. Besides a modest increase in TNF-α levels and increased peripheral blood neutrophil counts in CPEfat/fat mice, there were not differences in lung or serum cytokines after infection. These results suggest that obesity, accompanied by hyperglycemia and modestly elevated triglycerides, at least in the case of CPEfat/fat mice, does not impair innate immunity against pneumococcal pneumonia.

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Hyperglycemia in diabetics and non-diabetics: Effect on the risk for and severity of pneumococcal pneumonia

Cited by 49 publications

References 30 publications

Association of Hyperglycemia on Admission and During Hospitalization with Mortality in Diabetic Patients Admitted for Pneumonia

Association of Hyperglycemia on Admission and During Hospitalization with Mortality in Diabetic Patients Admitted for Pneumonia

Long-term mortality after community-acquired pneumonia—impacts of diabetes and newly discovered hyperglycaemia: a prospective, observational cohort study

No Impairment in Host Defense against Streptococcus pneumoniae in Obese CPEfat/fat Mice

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