title: Admission hypoglycemia and increased mortality in patients hospitalized with pneumonia.
abstract: BACKGROUND
  The relationship between spontaneous admission hypoglycemia and mortality in patients hospitalized with community-acquired pneumonia is unclear.
  
  
  METHODS
  From 2000 to 2002, clinical data were prospectively collected on all patients with community-acquired pneumonia who were admitted to all 6 hospitals in Edmonton, Alberta, Canada. Patients with admission glucose greater than 6.1 mmol/L (n=1996) were excluded; the remaining patients were categorized as having admission hypoglycemia (<4.0 mmol/L [n=54]) or normoglycemia (4.0 to< or =6.1 mmol/L [n=902]). Multivariable Cox proportional hazards models were used to examine the relationship between hypoglycemia and all-cause mortality in-hospital, at 30 days, and at 1 year.
  
  
  RESULTS
  The mean age was 65 (standard deviation=20) years, 48% were female, 8% had diabetes, and 56% had severe pneumonia. Overall, admission hypoglycemia was present in 2% (54/2990) of the entire cohort and 6% of those with glucose of 6.1 mmol/L or less. Total deaths were 89 (9%) in-hospital, 96 (10%) at 30 days, and 247 (26%) at 1 year. In-hospital mortality was higher among patients with admission hypoglycemia (11 [20%] deaths) compared with those with normoglycemia (78 [9%]; adjusted hazards ratio [aHR] 2.96; 95% confidence interval [CI], 1.39-6.31; P=.005). An increased risk of mortality was observed at 30 days (11 [20%] vs 85 [10%]; aHR 2.89; 95% CI, 1.32-6.29) and remained elevated at 1 year (19 [35%] vs 228 [25%]; aHR1.80; 95% CI, 1.02-3.17). These results were not influenced by treatment for diabetes (P>.4 for interaction).
  
  
  CONCLUSIONS
  In a population-based sample of patients with community-acquired pneumonia, spontaneous admission hypoglycemia was independently associated with increased mortality during hospitalization that persisted to 1 year. Patients with hypoglycemia are an easily identified group that may warrant more intensive inpatient and postdischarge follow-up.
authors.affiliation: Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: John-Michael
authors.initials: JM
authors.lastname: Gamble
authors.forename: Dean T
authors.initials: DT
authors.lastname: Eurich
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Marrie
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
mesh_terms: D000416:Alberta / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007003:Hypoglycemia / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011014:Pneumonia / Q000150:complications / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends