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

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.

[1]  I. Vanhorebeek,et al.  Intensive insulin therapy for the critically ill patient , 2008 .

[2]  Johny Verschakelen,et al.  High-dose acetylcysteine in idiopathic pulmonary fibrosis. , 2005, The New England journal of medicine.

[3]  D. Baines,et al.  Glucose in bronchial aspirates increases the risk of respiratory MRSA in intubated patients , 2005, Thorax.

[4]  J. Krinsley,et al.  Intensive glycemic management in critically ill patients. , 2005, Joint Commission journal on quality and patient safety.

[5]  Brian H Rowe,et al.  The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. , 2005, Diabetes care.

[6]  C. Wolf‐peeters,et al.  Protection of hepatocyte mitochondrial ultrastructure and function by strict blood glucose control with insulin in critically ill patients , 2005, The Lancet.

[7]  JoAnn E Manson,et al.  Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in women. , 2004, Diabetes care.

[8]  B. Philips,et al.  Effect of hyperglycaemia on glucose concentration of human nasal secretions. , 2004, Clinical science.

[9]  L. Robinson,et al.  Insulin resistance and hyperglycemia in critical illness: role of insulin in glycemic control. , 2004, AACN clinical issues.

[10]  D. Forman,et al.  Delays in managing lung cancer. , 2004, Thorax.

[11]  G. Van den Berghe.  How does blood glucose control with insulin save lives in intensive care? , 2004, The Journal of clinical investigation.

[12]  T. Evans,et al.  Glucose control and mortality in critically ill patients. , 2004, JAMA.

[13]  B. Philips,et al.  Factors determining the appearance of glucose in upper and lower respiratory tract secretions , 2003, Intensive Care Medicine.

[14]  G. Tinkoff,et al.  Admission hyperglycemia as a prognostic indicator in trauma. , 2003, The Journal of trauma.

[15]  G. Diette,et al.  In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. , 2003, Archives of internal medicine.

[16]  A. Buist.  Guidelines for the management of chronic obstructive pulmonary disease. , 2002, Respiratory medicine.

[17]  A. Kitabchi,et al.  Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. , 2002, The Journal of clinical endocrinology and metabolism.

[18]  M Schetz,et al.  Intensive insulin therapy in critically ill patients. , 2001, The New England journal of medicine.

[19]  H. Gerstein,et al.  Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients: A Systematic Overview , 2001, Stroke.

[20]  R. Pauwels,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. , 2001, American journal of respiratory and critical care medicine.

[21]  S. Yamashita,et al.  Longer-term diabetic patients have a more frequent incidence of nosocomial infections after elective gastrectomy. , 2000, Anesthesia and analgesia.

[22]  S. Nava,et al.  Incidence and causes of non-invasive mechanical ventilation failure after initial success. , 2000, Thorax.

[23]  N. Pride,et al.  Recent trends in physician diagnosed COPD in women and men in the UK , 2000, Thorax.

[24]  H. Gerstein,et al.  Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview , 2000, The Lancet.

[25]  S. Geerlings,et al.  Immune dysfunction in patients with diabetes mellitus (DM). , 1999, FEMS immunology and medical microbiology.

[26]  F. Brancati,et al.  Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. , 1999, Diabetes care.

[27]  J. Pomposelli,et al.  Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. , 1998, JPEN. Journal of parenteral and enteral nutrition.

[28]  BTS Guidelines for the Management of Chronic Obstructive Pulmonary Disease , 1997, Thorax.

[29]  F. Forastiere,et al.  Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. , 1997, The European respiratory journal.

[30]  P. Sly,et al.  Allergic respiratory disease: strategic targets for primary prevention during childhood. , 1997, Thorax.

[31]  S. Loukides,et al.  The effect of diabetes mellitus on the outcome of patients with chronic obstructive pulmonary disease exacerbated due to respiratory infections. , 1996, Respiration; international review of thoracic diseases.

[32]  J Herlitz,et al.  Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. , 1995, Journal of the American College of Cardiology.

[33]  D. Flenley,et al.  RESPIRATORY FAILURE REVISITED: ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS BETWEEN 1961-68 AND 1970-76 , 1980, The Lancet.