title: Association of hyperglycemia on admission and during hospitalization with mortality in diabetic patients admitted for pneumonia.
abstract: OBJECTIVE
  Information available on the clinical features and outcomes of pneumonia in diabetic patients is limited. There are no data on the association between glycemic control during hospitalization and mortality in this population. The objective of this study is to examine whether the presence of hyperglycemia on admission and during hospitalization is associated with mortality in diabetic patients admitted to the hospital for pneumonia.
  
  
  METHODS
  This study is a retrospective observational cohort study of diabetic adults hospitalized for the first time for pneumonia between 2005 and 2011 in a 358-bed community hospital. Univariate and multivariate analyses were performed for 30-day all-cause hospital mortality adjusted for sex, age, type of pneumonia (community-acquired pneumonia or nursing and health care-associated pneumonia), severity of pneumonia according to the A-DROP score and various comorbidities in consideration of the serum glucose and hemoglobin A1c levels on admission and the mean plasma glucose level during hospitalization.
  
  
  RESULTS
  Of the 1,499 pneumonia patients evaluated, 185 (12.3%) (mean age 75 years) had diabetes mellitus. Fourteen (7.6%) of the 185 diabetic patients died within 30 days after admission. According to the univariate analysis, 30-day mortality was significantly associated with the A-DROP score (p<0.0001), the admission glucose level (p=0.01) and the mean plasma glucose level during hospitalization (p<0.0001). Even after adjusting for factors related to the severity of pneumonia, the mean plasma glucose level during hospitalization remained significantly associated with 30-day mortality (p=0.004).
  
  
  CONCLUSIONS
  Hyperglycemia determined according to the mean plasma glucose level during hospitalization is independently associated with 30-day all-cause hospital mortality in diabetic patients admitted for pneumonia.
authors.affiliation: Department of Diabetes and Endocrinology, Kobe City Medical Center West Hospital, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Hirata
authors.forename: Hiromi
authors.initials: H
authors.lastname: Tomioka
authors.forename: Reina
authors.initials: R
authors.lastname: Sekiya
authors.forename: Shyuji
authors.initials: S
authors.lastname: Yamashita
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kaneda
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kida
authors.forename: Chihiro
authors.initials: C
authors.lastname: Nishio
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kaneko
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujii
authors.forename: Takehiro
authors.initials: T
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D048909:Diabetes Complications / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D011014:Pneumonia / Q000150:complications* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose