title: An Elevated Glycemic Gap is Associated With Adverse Outcomes in Diabetic Patients With Community-Acquired Pneumonia.
abstract: Several studies argue against the association between admission hyperglycemia and adverse outcomes in infected diabetic patients. When investigating the association, it is necessary to consider preexisting hyperglycemia. The objective of this study was to assess whether stress-induced hyperglycemia, determined by the glycemic gap between admission glucose levels and A1c-derived average glucose levels adversely affects outcomes in diabetic patients admitted to hospital with community-acquired pneumonia (CAP).We retrospectively analyzed the glycemic gap and adverse outcomes of diabetic patients hospitalized because of CAP from June 1, 2007 to August 31, 2012 in single medical center in Taiwan.A total of 203 patients admitted with principal diagnosis of CAP and available data of glycemic gap.Patients with glycemic gaps ≥40 mg/dL had greater AUROC values for the development of adverse outcomes compared with acute hyperglycemia and long-term glycemic controls. Patients with an elevated glycemic gap had an odds ratio of 3.84 for the incidence of combined adverse outcomes. Incorporation of the glycemic gap into pneumonia severity index, CURB-65 or SMART-COP scores, increased the discriminative performance of predicting the development of adverse outcomes.Glycemic gaps were associated with adverse outcomes of diabetic CAP patients. The discriminative performance of the calculated glycemic gaps was comparable with those of current clinical scoring systems and may further increase the AUROC of each system.
authors: From the Department of Emergency Medicine (PCC, WIL, YHC, SHT); Department of Family Medicine (YCW); Department of Radiology, Tri-Service General Hospital, National Defense Medical Center (WCC); and Department of Emergency and Critical Care Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan (CWH).
authors: Po-Chuan
authors: PC
authors: Chen
authors: Wen-I
authors: WI
authors: Liao
authors: Ying-Chuan
authors: YC
authors: Wang
authors: Wei-Chou
authors: WC
authors: Chang
authors: Chin-Wang
authors: CW
authors: Hsu
authors: Ying-Hsin
authors: YH
authors: Chen
authors: Shih-Hung
authors: SH
authors: Tsai
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D017714:Community-Acquired Infections / Q000097:blood / Q000150:complications / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose