Association of hypoglycemia with mortality for subjects hospitalized with pneumonia.
Association of hypoglycemia with mortality for subjects hospitalized with pneumonia.
复制标题
DOI：
10.1097/maj.0b013e3181ca43fe
复制
发表时间：
2010-03
期刊：
影响因子：
--
通讯作者：
Anzueto A
中科院分区：
文献类型：
--
作者：
Mortensen EM;Garcia S;Leykum L;Nakashima B;Restrepo MI;Anzueto A
先前的研究表明，低血糖与老年人、败血症和肺炎儿童的预后较差有关。这项研究的目的是检查低血糖(70 mg/dL)是否与成人肺炎住院患者30天死亡率的增加有关，在调整了潜在的混杂因素后。一项在两家三级教学医院进行的回顾性队列研究。符合条件的受试者被诊断为社区获得性肺炎，并有符合社区获得性肺炎的胸部X光检查。我们的主要分析是以30天死亡率为因变量的多变量Logistic回归，以低血糖、糖尿病、肺炎严重程度指数和肺炎相关护理过程为自变量。对这两家医院的787名受试者的数据进行了摘要。30日龄死亡率为8.1%。在陈述时，55%的受试者为低风险，33%为中等风险，12%为高风险。在我们的队列中，有2.8%(n=22)的患者出现低血糖。低血糖患者的未调整死亡率为27.3%，非低血糖患者为8.6%(p=0.0003)。在多变量分析中，低血糖(优势比4.1，95%可信区间1.4-11.7)与30天死亡率显著相关。在调整了疾病的严重程度和其他潜在的混杂因素后，低血糖与肺炎住院患者30天的死亡率显著相关。低血糖患者应该被置于严密监测的环境中，即使通过肺炎特有的风险系统，他们通常也会出院。
Prior research has shown that hypoglycemia is associated with worse outcomes for the elderly, in sepsis, and in children with pneumonia. The purpose of this study was to examine whether hypoglycemia (< 70 mg/dL) is associated with increased 30-day mortality, after adjusting for potential confounders, for adults hospitalized with pneumonia. A retrospective cohort study conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of, and had a chest x-ray consistent with, community-acquired pneumonia. Our primary analysis was a multivariable logistic regression with the dependent variable of 30-day mortality with independent variable of hypoglycemia, diabetes, severity of illness utilizing the Pneumonia Severity Index, and pneumonia-related processes of care. Data were abstracted on 787 subjects at the two hospitals. Mortality was 8.1% at 30-days. At presentation, 55% of subjects were low risk, 33% were moderate risk, and 12% were high risk. In our cohort 2.8% (n=22) had hypoglycemia at presentation. Unadjusted mortality for those who were hypoglycemic was 27.3% vs. 8.6% for those who were not (p=0.0003). In the multivariable analysis, hypoglycemia (odds ratio 4.1, 95% confidence interval 1.4–11.7) was significantly associated with 30-day mortality. After adjusting for severity of illness and other potential confounders hypoglycemia is significantly associated with 30-day mortality for patients hospitalized with pneumonia. Patients with hypoglycemia should be placed in closely monitored settings even when by pneumonia specific risk systems they would normally be discharged.