title: Association of hypoglycemia with mortality for subjects hospitalized with pneumonia.
abstract: BACKGROUND
  Previous research has shown that hypoglycemia is associated with worse outcomes for the elderly, in sepsis, and in children with pneumonia. The purpose of this study was to examine whether hypoglycemia (<70 mg/dL) is associated with increased 30-day mortality, after adjusting for potential confounders, for adults hospitalized with pneumonia.
  
  
  METHODS
  A retrospective cohort study conducted at 2 tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of, and had a chest x-ray consistent with, community-acquired pneumonia. Our primary analysis was a multivariable logistic regression with the dependent variable of 30-day mortality and with independent variable of hypoglycemia, diabetes, severity of illness determined using the pneumonia severity index, and pneumonia-related processes of care.
  
  
  RESULTS
  Data were abstracted on 787 subjects at the 2 hospitals. Mortality was 8.1% at 30 days. At presentation, 55% of subjects were at low risk, 33% were at moderate risk, and 12% were at high risk. In our cohort, 2.8% (n = 22) had hypoglycemia at presentation. Unadjusted mortality for those who were hypoglycemic was 27.3% versus 8.6% for those who were not (P = 0.0003). In the multivariable analysis, hypoglycemia (odds ratio: 4.1, 95% confidence interval: 1.4-11.7) was significantly associated with 30-day mortality.
  
  
  CONCLUSIONS
  After adjusting for severity of illness and other potential confounders, hypoglycemia is significantly associated with 30-day mortality for patients hospitalized with pneumonia. Patients with hypoglycemia should be placed in closely monitored settings even when by pneumonia specific risk systems they would normally be discharged.
authors.affiliation: VERDICT research program, Medicine Service, Audie L. Murphy Division-South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
authors.forename: Sean
authors.initials: S
authors.lastname: Garcia
authors.forename: Luci
authors.initials: L
authors.lastname: Leykum
authors.forename: Brandy
authors.initials: B
authors.lastname: Nakashima
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies