Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease
Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease
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DOI：
10.1136/thx.2005.051029
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发表时间：
2006-04-01
期刊：
影响因子：
10
通讯作者：
Jones, PW
中科院分区：
文献类型：
--
作者：
Baker, EH;Janaway, CH;Jones, PW
背景：高血糖与肺炎、心肌梗死和中风的不良预后相关，但血糖对慢性阻塞性肺疾病急性加重期（AECOPD）预后的影响尚未确定。最近的英国指南没有对AECOPD患者的血糖测量或控制发表评论。因此，开展了一项研究，以确定AECOPD患者的血糖浓度、住院时间和死亡率之间的关系。方法：检索2001 ~ 2002年住院的AECOPD合并下呼吸道感染患者的电子病历资料。按血糖四分位数分组（1组，9.0 mmol/ l (n = 71)）。结果：与第1组相比，第3组患者死亡或长时间住院的相对危险度（RR）显著升高（RR 1.46, 95% CI 1.05 ~ 2.02, p = 0.02），第4组患者死亡或长时间住院的相对危险度（RR 1.97, 95% CI 1.33 ~ 2.92, p< 0.0001）。血糖每升高1 mmol/ l，不良结局的绝对风险增加15% (95% CI 4 ~ 27), p = 0.006。不良结局的风险随着高血糖的增加而增加，与年龄、性别、既往糖尿病诊断和COPD严重程度无关。痰中多种病原菌和金黄色葡萄球菌的分离率也随血糖升高而升高。结论：AECOPD患者血糖浓度升高与不良临床结局相关。严格控制血糖可降低重症监护或心肌梗死后患者的死亡率。现在需要一项前瞻性研究来确定控制血糖是否也能改善AECOPD的预后。
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. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD.Methods: Data were retrieved from electronic records for patients admitted with AECOPD with lower respiratory tract infection in 2001 - 2. The patients were grouped according to blood glucose quartile ( group 1, 9.0 mmol/ l ( n = 71)).Results: The relative risk (RR) of death or long inpatient stay was significantly increased in group 3 ( RR 1.46, 95% CI 1.05 to 2.02, p = 0.02) and group 4 ( RR 1.97, 95% CI 1.33 to 2.92, p< 0.0001) compared with group 1. For each 1 mmol/ l increase in blood glucose the absolute risk of adverse outcomes increased by 15% ( 95% CI 4 to 27), p = 0.006. The risk of adverse outcomes increased with increasing hyperglycaemia independent of age, sex, a previous 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 are associated with adverse clinical outcomes in patients with AECOPD. Tight control of blood glucose reduces mortality in patients in 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.