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

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3397 (Published 29 May 2012) Cite this as: BMJ 2012;344:e3397
  1. Philipp M Lepper, consultant physician1,
  2. Sebastian Ott, consultant physician2,
  3. Eveline Nüesch, statistician34,
  4. Maximilian von Eynatten, consultant physician5,
  5. Christian Schumann, consultant physician6,
  6. Mathias W Pletz, professor7,
  7. Nicole M Mealing, statistician34,
  8. Tobias Welte, professor8,
  9. Torsten T Bauer, professor9,
  10. Norbert Suttorp, professor10,
  11. Peter Jüni, professor34,
  12. Robert Bals, professor1,
  13. Gernot Rohde, professor11
  14. on behalf of the German Community Acquired Pneumonia Competence Network (CAPNETZ)
  1. 1Department of Internal Medicine V, University Hospital of Saarland, D-66421, Homburg, Germany
  2. 2Department of Pneumology, University Hospital of Bern (Inselspital) and University of Bern, Bern, Switzerland
  3. 3Clinical Trials Unit, University Hospital of Bern (Inselspital) and University of Bern
  4. 4Institute of Social and Preventive Medicine, University of Bern
  5. 5Department of Diabetes, Endocrinology and Clinical Chemistry, University Hospital of Heidelberg, Heidelberg, Germany
  6. 6Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
  7. 7Division of Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Jena, Germany
  8. 8Department of Pneumology, Hannover Medical School, University of Hannover, Hannover, Germany
  9. 9Department of Pneumology, Lungenklinik Heckeshorn, Klinikum Emil von Behring, Berlin, Germany
  10. 10Department of Pneumology and Infectious Diseases, University Hospital of Berlin (Charité), Berlin, Germany
  11. 11Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
  1. Correspondence to: P M Lepper philipp.lepper{at}uks.eu
  • Accepted 17 April 2012

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.

Footnotes

  • We thank the clinical doctors and doctors in private practice who saw and identified patients with community acquired pneumonia for their work dedicated to CAPNETZ; the CAPNETZ study team either temporarily or permanently involved in patient recruitment and sample and data handling; and the patients included in the CAPNETZ study. See supplementary file for members of the CAPNETZ study group.

  • Contributors: PML contributed to the conception and design of this particular CAPNETZ substudy, was involved in data analysis and interpretation, and drafted the manuscript. SO contributed to the conception and design of this particular CAPNETZ sub-study, was involved in data analysis and interpretation, and revised the manuscript critically for important intellectual content. PML and SO contributed equally to the manuscript. EN was involved in data analysis and interpretation, drafted the figures and tables, and revised the manuscript critically for important intellectual content. MvE contributed to the conception and design of this particular CAPNETZ substudy, was involved in data analysis and interpretation, and revised the manuscript critically for important intellectual content. CS and MWP were involved in data analysis and interpretation and revised the manuscript critically for important intellectual content. NMM did the statistical analysis for the revised version of the manuscript and revised the manuscript critically for important intellectual content.TW and NS were involved in data analysis and interpretation, revised the manuscript critically for important intellectual content, and contributed to the conception and design of the ongoing CAPNETZ study. TTB contributed to the conception and design of this particular CAPNETZ substudy, was involved in data interpretation, and revised the manuscript critically for important intellectual content. PJ contributed to the conception and design of this particular CAPNETZ study and revised the manuscript critically for important intellectual content. RB and GR were involved in data analysis and interpretation and revised the manuscript critically for important intellectual content. All authors approved the final version of the manuscript. PML is the guarantor.

  • Funding: CAPNETZ is funded by the German Ministry of Education and Research, BundesministeriumfürBildung und Forschung (grant No 01KI07145).

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the institutional review board of the Otto-von-Guericke University, Magdeburg, Germany (104/01) in 2001.

  • Data sharing: No additional data available.

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