title: Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Glucose and Pulmonary Infection Group, Cardiac and Vascular Sciences (Respiratory), St George's, University of London, Cranmer Terrace, London SW17 0RE, UK. ebaker@sgul.ac.uk
authors.forename: E H
authors.initials: EH
authors.lastname: Baker
authors.forename: C H
authors.initials: CH
authors.lastname: Janaway
authors.forename: B J
authors.initials: BJ
authors.lastname: Philips
authors.forename: A L
authors.initials: AL
authors.lastname: Brennan
authors.forename: D L
authors.initials: DL
authors.lastname: Baines
authors.forename: D M
authors.initials: DM
authors.lastname: Wood
authors.forename: P W
authors.initials: PW
authors.lastname: Jones
mesh_terms: D000208:Acute Disease; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000401:mortality; D008297:Male; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications* / Q000401:mortality; D012307:Risk Factors; D013147:Spirometry; D013183:Sputum / Q000382:microbiology
chemical_list: D001786:Blood Glucose