title: Admission hypoglycaemia is associated with adverse outcome in community-acquired pneumonia.
abstract: The aim of our study was to investigate if hypoglycaemia correlates with outcome in community-acquired pneumonia (CAP). We performed a prospective, observational study of consecutive patients presenting with a primary diagnosis of CAP in Lothian (UK). Admission plasma glucose was measured and, on this basis, patients were divided into two groups, hypoglycaemic (<4.4 mmol x L(-1) or <79.0 mg x dL(-1)) and nonhypoglycaemic (> or = 4.4 mmol x L(-1) or > or = 79.0 mg x dL(-1)). Outcomes of interest were 30-day mortality, need for mechanical ventilation and inotropic support. Multivariable logistic regression was used to compare these outcomes in hypoglycaemic patients to nonhypoglycaemic patients, adjusting for diabetes mellitus, prior statin use and Pneumonia Severity Index. In total, 1,050 patients were included in the study with 5.4% classified as hypoglycaemic. Increased rates of 30-day mortality (28.1% versus 7.5%, p<0.0001), need for mechanical ventilation (29.8% versus 6.5%, p<0.0001) and need for inotropic support (21.1% versus 4.8%, p<0.0001) were observed in hypoglycaemic patients compared with nonhypoglycaemic patients. On multivariable analysis, hypoglycaemia was independently associated with increased 30-day mortality (OR 2.25, 95% CI 1.1-4.7; p = 0.03), need for mechanical ventilation (OR 3.8, 95% CI 1.9-7.5; p = 0.0002) and need for inotropic support (OR, 2.9, 95% CI 1.4-6.3; p = 0.0006). Admission hypoglycaemia is associated with increased 30-day mortality, need for mechanical ventilation and inotropic support in patients presenting with CAP.
authors.affiliation: Dept of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK. aransinga@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Singanayagam
authors.forename: J D
authors.initials: JD
authors.lastname: Chalmers
authors.forename: A T
authors.initials: AT
authors.lastname: Hill
mesh_terms: D000368:Aged; D001786:Blood Glucose; D017714:Community-Acquired Infections / Q000401:mortality*; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose