High Glucose Levels Predict Mortality in Pneumonia

Nondiabetic patients who have elevated serum glucose levels when they are admitted to the hospital with pneumonia have an increased risk of dying within 90 days.

Acute hyperglycemia associated with community-acquired pneumonia (CAP) can identify at-risk patients who need additional care to reduce their risk for mortality, compared with similar normoglycemic patients.

Scientists from the University Hospital of Saarland (Homburg, Germany) evaluated whether acute dysglycemia could predict a poor outcome in patients with CAP who had not been diagnosed with diabetes. They studied data from 6,891 adults with CAP who were enrolled in a prospective study from 2003 to 2009. The investigators also calculated various comorbidities for one month, three months and six months mortality on the basis of serum glucose levels at hospital admission. The majority of the patients were male, and the mean age was 60 years.

At the time of hospital admission, patients who had glucose levels from 6 to 11 mmol/L (108-198 mg/dL) were considered to have mild acute hyperglycemia and patients who had glucose levels of 14 mmol/L (252 mg/dL) or more were considered to have acute hyperglycemia. In all, 40% of CAP patients presented with hyperglycemia. An elevated glucose level at hospital admission was an independent predictor of one month, three months and six months mortality in CAP patients. In fact, increasing glucose levels corresponded to increasing risk for death from CAP.

Patients with mild to moderate hyperglycemia had a significantly higher hazard ratio (HR) for mortality at 90 days than patients with normal glucose levels at hospital admission. In patients presenting with acute hyperglycemia, HR increased to 6.04. In patients previously diagnosed with diabetes, there was no association between glucose level at admission and mortality. However, there was a nearly two-fold increased risk of dying in the 16% of patients with preexisting diabetes.

Philipp M. Lepper, MD, the senior investigator, said, "Increased serum glucose levels at admission are a risk factor for death among patients with community-acquired pneumonia. The risk for mortality starts to increase when serum glucose levels are slightly increased but remain below the defined threshold for overt diabetes." The study was presented on September 2, 2012, at the European Respiratory Society (ERS) 2012 Annual Congress held in Vienna Austria.

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University Hospital of Saarland