The association between glucose levels and hospital outcomes in patients with acute exacerbations of chronic obstructive pulmonary disease

Abstract

BACKGROUND:Corticosteroids used for chronic obstructive pulmonary disease (COPD) exacerbations can cause hyperglycemia in hospitalized patients, and hyperglycemia may be associated with increased mortality, length of stay (LOS), and re-admissions in these patients.MATERIALS AND METHODS:We did three retrospective studies using charts from July 2008 through June 2009, January 2006 through December 2010, and October 2010 through March 2011. We collected demographic and clinical information, laboratory results, radiographic results, and information on LOS, mortality, and re-admission.RESULTS:Glucose levels did not predict outcomes in any of the studied cohorts, after adjustment for covariates in multivariable analysis. The first database included 30 patients admitted to non-intensive care unit (ICU) hospital beds. Six of 20 non-diabetic patients had peak glucoses above 200 mg/dl. Nine of the ten diabetic patients had peak glucoses above 200 mg/dl. The maximum daily corticosteroid dose had no apparent effect on the glucose levels. The second database included 217 patients admitted to ICUs. The initial blood glucose was higher in patients who died than those who survived using bivariate analysis (P = 0.015; odds ratio, OR, 1.01) but not in multivariable analysis. Multivariable logistic regression analysis also demonstrated that glucose levels did not affect LOS. The third database analyzing COPD re-admission rates included 81 patients; the peak glucose levels were not associated with re-admission.CONCLUSIONS:Our data demonstrate that COPD patients treated with corticosteroids developed significant hyperglycemia, but the increase in blood glucose levels did not correlate with the maximum dose of corticosteroids. Blood glucose levels were not associated with mortality, LOS, or re-admission rates.

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

“…demonstrated that the highest glucose value during the first 24 h after ICU admission did not predict hospital mortality in the medical ICU 59 . Patients with chronic obstructive lung diseases treated with corticosteroids developed significant hyperglycemia, but the increase in blood glucose levels did not correlate with the maximum dose of corticosteroids and were not associated with mortality, length of hospital stay, or re-admission rates 60 . The duration of hyperglycemia or the amount of insulin given did not have a major impact on the outcome of patients with primary acute neuromuscular respiratory failure 61 .…”

Usefulness of Glycemic Gap to Predict ICU Mortality in Critically Ill Patients With Diabetes

“… 25 In addition, among patients with chronic obstructive lung disease treated with corticosteroids who developed significant hyperglycemia, the increase in blood glucose levels did not correlate with the maximum corticosteroid dose, mortality, length of hospital stay, or readmission rates. 26 Moreover, neither the duration of hyperglycemia nor the amount of insulin administered affects the outcomes of patients with primary neuromuscular ARF. 27 …”

Bronchoalveolar pH and inflammatory biomarkers in patients with acute exacerbation of chronic obstructive pulmonary disease

“…While blood glucose levels are not related to mortality, hospital stay duration, or re-hospitalization in patients with AECOPD, 28 detection of glucose in bronchoalveolar aspirate is associated with the presence of pathogenic bacteria. 29,30 In the present study, if bacteria were isolated in patients with AECOPD, BA-Glu levels were 1.8 times lower than those in patients without bacterial isolation, while no difference was found in S-Glu levels.…”