Article Text

Hyperglycaemia as a predictor of outcome during non-invasive ventilation in decompensated COPD
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  1. B Chakrabarti1,
  2. R M Angus2,
  3. S Agarwal2,
  4. S Lane3,
  5. P M A Calverley1
  1. 1
    Clinical Sciences Centre, University Hospital Aintree, University of Liverpool, Liverpool, UK
  2. 2
    Aintree Chest Centre, University Hospital Aintree, Liverpool, UK
  3. 3
    Centre for Medical Statistics and Health Evaluation, University of Liverpool, UK
  1. Correspondence to Dr B Chakrabarti, Aintree Chest Centre, University Hospital Aintree, Liverpool L9 7AL, UK; biz{at}doctors.org.uk

Abstract

Rationale: Hyperglycaemia predicts a poor outcome in Intensive Care Unit (ICU) patients. Whether this is true for respiratory failure necessitating non-invasive ventilation (NIV) is not known.

Objectives: To determine whether hyperglycaemia within 24 h of admission independently predicts outcome of NIV during acute decompensated ventilatory failure complicating chronic obstructive pulmonary disease (COPD) exacerbations.

Methods: Patients with COPD presenting with acute hypercapnic respiratory failure at University Hospital Aintree between June 2006 and September 2007 and receiving NIV within 24 h of admission were studied prospectively. Random blood glucose levels were measured before NIV administration.

Results: 88 patients (mean baseline pH 7.25, PaCO2 10.20 kPa, and PaO2 8.19 kPa) met the inclusion criteria, with NIV normalising arterial pH off therapy in 79 (90%). After multivariate logistic regression, the following predicted outcome: baseline respiratory rate (OR 0.91; 95% CI 0.84 to 0.99), random glucose ⩾7 mmol/l (OR 0.07; 95% CI 0.007 to 0.63) and admission APACHE II (Acute Physiology and Chronic Health Evaluation II) score (OR 0.75; 95% CI 0.62 to 0.90). The combination of baseline respiratory rate (RR) <30 breaths/min and random glucose <7 mmol/l increased prediction of NIV success to 97%, whilst use of all three factors was 100% predictive.

Conclusions: In acute decompensated ventilatory failure complicating COPD, hyperglycaemia upon presentation was associated with a poor outcome. Baseline RR and hyperglycaemia are as good at predicting clinical outcomes as the APACHE II score. Combining these variables increases predictive accuracy, providing a simple method of early risk stratification.

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Footnotes

  • Funding This study was funded by a grant from the British Lung Foundation (BLF).

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • See Editorial, p 830

  • Ethics approval Ethical approval was obtained from North Cheshire Research Ethics. Committee.

  • ▸ Additional tables and details of local protocols and of the six cases where COPD was diagnosed clinically are published online only at http://thorax.bmj.com/content/vol64/issue10

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