Hyperglycaemia is associated with poor outcomes in people admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease

Emma H Baker ^1*, Christopher H Janaway ¹, Barbara J Philips ¹, Amanda L Brennan ¹, Deborah L Baines ¹, David M Wood ¹ and Paul W Jones ¹

¹ St George's, University of London, United Kingdom

^* To whom correspondence should be addressed. E-mail: ebaker{at}sgul.ac.uk.

Accepted 4 January 2006

Abstract

Background: Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. We therefore determined the relationship between blood glucose concentrations, length of stay and mortality in people admitted with AECOPD.

Methods: Data was retrieved from electronic records for patients admitted with "AECOPD with Lower Respiratory Tract Infection" in 2001-2. Patients were divided by blood glucose quartile (Group 1, <6mmol.L^-1 (n=69); Group 2, 6.0-6.9mmol.L^-1 (n=69); Group 3, 7.0-8.9mmol.L^-1 (n=75); and Group 4, >9.0mmol.L^-1 (n=71)).

Results: Relative risk (RR) of death or long in-patient stay was significantly increased in Group 3 (RR 1.46 [95% CI: 1.05-2.02] (p=0.02) and Group 4 (RR 1.97 [95% CI: 1.33-2.92] (p<0.0001), compared to Group 1. For each 1mmol.L^-1 increase in blood glucose the absolute risk of adverse outcomes increased by 15% [95% CI: 4-27%] (p=0.006). The risk of adverse outcomes increased with increasing hyperglycaemia, independent of age, gender, prior diagnosis of diabetes and COPD severity. Isolation of multiple pathogens and Staphylococcus aureus from sputum also increased with increasing blood glucose.

Conclusion: Increasing blood glucose concentrations were associated with adverse clinical outcomes in people with AECOPD. Tight control of blood glucose reduced mortality in people on intensive care or following myocardial infarction. A prospective study is now required to determine whether control of blood glucose can also improve outcomes from AECOPD.

Keywords: COPD, hyperglycaemia, length of stay, mortality, nosocomial infection

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