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BMJ. 2012 May 28;344:e3397. doi: 10.1136/bmj.e3397.

Serum glucose levels for predicting death in patients admitted to hospital for community acquired pneumonia: prospective cohort study.

Author information

  • 1Department of Internal Medicine V, University Hospital of Saarland, D-66421, Homburg, Germany. philipp.lepper@uks.eu

Abstract

OBJECTIVE:

To examine whether acute dysglycaemia predicts death in people admitted to hospital with community acquired pneumonia.

DESIGN:

Multicentre prospective cohort study.

SETTING:

Hospitals and private practices in Germany, Switzerland, and Austria.

PARTICIPANTS:

6891 patients with community acquired pneumonia included in the German community acquired pneumonia competence network (CAPNETZ) study between 2003 and 2009.

MAIN OUTCOME MEASURES:

Univariable and multivariable hazard ratios adjusted for sex, age, current smoking status, severity of community acquired pneumonia using the CRB-65 score (confusion, respiratory rate >30/min, systolic blood pressure ≤ 90 mm Hg or diastolic blood pressure ≤ 60 mm Hg, and age ≥ 65 years), and various comorbidities for death at 28, 90, and 180 days according to serum glucose levels on admission.

RESULTS:

An increased serum glucose level at admission to hospital in participants with community acquired pneumonia and no pre-existing diabetes was a predictor of death at 28 and 90 days. Compared with participants with normal serum glucose levels on admission, those with mild acute hyperglycaemia (serum glucose concentration 6-10.99 mmol/L) had a significantly increased risk of death at 90 days (1.56, 95% confidence interval 1.22 to 2.01; P<0.001), and this risk increased to 2.37 (1.62 to 3.46; P<0.001) when serum glucose concentrations were ≥ 14 mmol/L. In sensitivity analyses the predictive value of serum glucose levels on admission for death was confirmed at 28 days and 90 days. Patients with pre-existing diabetes had a significantly increased overall mortality compared with those without diabetes (crude hazard ratio 2.47, 95% confidence interval 2.05 to 2.98; P<0.001). This outcome was not significantly affected by serum glucose levels on admission (P = 0.18 for interaction).

CONCLUSIONS:

Serum glucose levels on admission to hospital can predict death in patients with community acquired pneumonia without pre-existing diabetes. Acute hyperglycaemia may therefore identify patients in need of intensified care to reduce the risk of death from community acquired pneumonia.

PMID:
22645184
[PubMed - indexed for MEDLINE]
PMCID:
PMC3362658
Free PMC Article

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