How does pneumonia affect blood glucose levels in non nondiabetic
Answers
hey that is your answer
Hyperglycaemia is frequent at admission in patients with and without diabetes mellitus (DM) [1]. It may be secondary to DM (diagnosed or undiagnosed) or stress. Stress-induced hyperglycaemia is a result of an increase in catecholamines, glucagon, growth hormone, proinflammatory cytokines and increased peripheral insulin resistance in response to physiological stress [2]. Systemic bacterial and viral infections are potent triggers of stress hyperglycaemia and this may also be the case for pneumonia.
Community-acquired pneumonia (CAP) remains a leading cause of hospitalisation and mortality worldwide [3, 4]. The incidence of hospitalisations caused by pneumonia has increased steadily worldwide [5]. Rates in Denmark have increased from 288 to 809 per 100 000 person-years over recent decades [6]. Previous studies have suggested that hyperglycaemia may be associated with severe outcome in a range of conditions, including sepsis [1, 7, 8]. In some CAP studies, an association with higher mortality has also been reported [9–12], while others have shown no association [13, 14]. Most studies have focused on the association between hyperglycaemia and long-term mortality (28–90 day mortality) after an episode of CAP [10, 13]. Thus, there is a need for further analysis on the impact of hyperglycaemia on morbidity and mortality associated with CAP, and particularly in-hospital mortality.
outcome in a similar model, unadjusted and adjusted. All statistical comparisons were two-sided and carried out at the 0.05 significance level.
Results
The CAP-NORTH cohort comprised 1320 patients with CAP [15], and data for 1318 patients were available for this study. Two patients were not included due to missing information on prior medical history. In total, 12.3% (162/1318) of patients were known to have DM at admittance (table 2). There were no differences between patients with and without DM with respect to age, nursing home residency and smoking habits, but more patients with DM were male (64.2% versus 45.1%, p=0.001) and more often had chronic cardiac and kidney disease. Patients with DM were less likely to have received antibiotic treatment prior to admission (29.4% versus 37.6%, p=0.04). Patients with DM had higher median admittance blood glucose levels (9.2 mmol·L−1 versus 6.8 mmol·L−1 (mM), p<0.001). 38% and 3% (p<0.001) of patients with and without DM had admittance blood glucose ≥11.1 mM, respectively. At the time of admission, more patients with DM (63.4% versus 44.6%, p<0.001) had signs of moderate to severe pneumonia according to CURB-65 (table 2), predominantly due to age >65 years and urea >7.0 mM.
TABLE 2
TABLE 2
Characteristics of patients with and without diabetes mellitus at time of admission
Association between admission blood glucose, DM and clinical course of CAP
We assessed whether the clinical course of CAP was different in patients with DM than in patients without DM, and found that LOS and LOIVAB for patients with DM were longer (6 days versus 5 days, p<0.001; 4 days versus 3 days, p=0.01) (table 3), whereas LOAB was similar in patients with and without DM (p=0.87). In order to adjust for potential confounders (CURB-65 score and comorbidities), we performed a linear regression analysis on log-transformed data, and found that LOS remained associated with DM, corresponding to a 22% (95% CI 5.15–41.37%) longer admission time compared to patients without DM. The association between DM and LOIVAB disappeared after adjusting (9%, 95% CI −5.27–26.20%).
TABLE 3
TABLE 3
Influence of diabetes mellitus on the clinical course of community-acquired pneumonia
Subsequently, we assessed the influence of admission blood glucose in an adjusted linear regression model and found that for each 1 mM increase in blood glucose, LOS increased by 2.8% (95% CI 0.70–4.25%) and the length of LOIVAB was extended by 1.4% (95% CI 0.03–3.01%). Blood glucose levels did not influence the LOAB.
Association between admission blood glucose levels and DM status and the risk of severe outcome
In total, 19.8% (32/162) patients with and 13.9% (161/1156) without DM had a severe outcome during hospital admission. This included admission to an ICU (13.0% versus 9.2%) and in-hospital death (10.5% versus 8.1%) (table 3).
The difference between patients with and without DM with regard to overall risk of severe outcome (ICU and/or in-hospital death) was borderline significant (OR 1.52, 95% CI 0.998–2.32, p=0.051) by univariate analysis, whereas the differences in risk of either ICU admittance or death were not significant (table 4).
TABLE 4
TABLE 4
Risk of severe outcome depending on diabetes status
By multivariate analysis adjusting for CURB-65 and comorbidity (table 4), DM was no longer associated with any overall severe outcome (OR 1.43, 95%
i hope that help you