The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia
The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia
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DOI：
10.2337/diacare.28.4.810
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发表时间：
2005-04-01
期刊：
影响因子：
16.2
通讯作者：
Marrie, TJ
中科院分区：
文献类型：
--
作者：
McAlister, FA;Majumdar, SR;Marrie, TJ
研究设计和方法-对2000年11月15日至2002年11月14日期间入住6家医院的连续患者进行前瞻性队列研究。本研究中的471例患者（中位年龄75岁），279例（11%）在就诊时血糖> 11 mmol/l：401例患者中有178例（44%）既往诊断为糖尿病，2,070例患者中有101例（5%）无糖尿病史。在因CAP住院的患者中，9%死亡，23%发生院内并发症。与数值11 mmol/l的患者相比，死亡风险（13 vs. 9%，P = 0.03）和院内并发症风险（29 vs. 22%，P = 0.01）增加。与入院时血糖> 61 mmol/l的患者相比，入院时血糖> 11 mmol/l的患者死亡风险高73%（95% CI 12-168%），院内并发症风险高52%（12-108%）。即使在调整了肺炎严重程度指数的因素后，入院时的高血糖仍然与随后的不良结局显著相关：每增加1 mmol/l，院内并发症的风险增加3%（0.2-6%）。结论-入院时的高血糖与CAP患者的不良结局独立相关，在较低的血糖水平下，风险增加明显高于以前的报道。
OBJECTIVE- To examine whether hyperglycemia at the time of presentation Was associated with outcomes in patients admitted to non-intensive care settings with community-acquired pneumonia (CAP).RESEARCH DESIGN AND METHODS - Prospective cohort study of consecutive patients admitted to six hospitals between 15 November 2000 and 14 November 2002.RESULTS - Of the 2,471 patients in this study (median age 75 years), 279 (11%) had serum glucose at presentation > 11 mmol/l: 178 of the 401 patients (44%) with a prior diagnosis of diabetes and 101 of the 2,070 patients (5%) without a history of diabetes. Of patients hospitalized With CAP, 9% died and 23% suffered an in-hospital complication. Compared with those with values 11 mmol/l had an increased risk of death (13 vs. 9%, P = 0.03) and in-hospital complications (29 vs. 22%, P = 0.01). Compared with those patients with admission glucose :: 61 mmol/l, the mortality risk was 73% higher (95% Cl 12-168%) and the in-hospital complication risk was 52% higher (12-108%) in patients with admission glucose > 11 mmol/l. Even after adjustment for factors in the Pneunomia Severity, Index, hyperglycemia on admission remained significantly associated with subsequent adverse outcomes: for each 1-mmol/l increase, risk of in-hospital complications increased 3% (0.2-6%).CONCLUSIONS - Hyperglycemia on admission is independently associated with adverse outcomes in patients with CAP, with the increased risks evident at lower glucose levels than previously reported.