Utjecaj stresne hiperglikemije na bolnički ishod akutne egzacerbacije kronične opstruktivne plućne bolesti [Impact of stress hyperglycemia on hospital outcome of acute exacerbation of chronic oobstructive pulmonary disease]

Abstract

Impact of stress hyperglycemia on outcomes from acute exacerbations of COPD (AECOPD) has not been established. The aim of the research is to determine the impact of stress hyperglycemia (blood glucose > 6,9 and 7,8 mmol/L postprandial) on intrahospital mortality, length of hospitalization and specific clinical parameters. We enrolled 272 non-diabetics hospitalized in General Hospital Zabok for AECOPD in one year period and divide them in 2 groups according to glucose levels in venous plasma at admission. After corticosteroid therapy each group was further stratified according to glycemia after 24 hours and before discharge. Beside main aims, we evaluated impact on lung function changes, CRP level, sputum culture, the presence of radiological pneumonia and need for mechanical ventilation. Results showed that 113 patients (41,5%) had stress hyperglycemia at admission and statistically significant higher average glucose levels (9,7 vs 5,7 mmol/l). Fatal outcome happened in 8,1 % cases and it was three times more often between patients with stress hyperglycemia (13,3 % vs 4,4%), independent of age, sex, FEV1 and COPD severity or duration . The relative risk (RR) of death or long inpatient stay was significantly increased in patients with stress hyperglycemia. For each 1 mmol/L increase in blood glucose the absolute risk of adverse outcome increased by 1,23 (95% CI. 1,04 to 1,46, p =0,015). Glucose levels at admission were much higher in non-survivors than survivors (9,65 vs 6,35 mmol/L). Length of hospital stay was longer in patients with stress hyperglycemia (9 vs 7 days, p= 0,001), so was the incidence of pneumonia (29,2% vs 10,1%, p<0,001). In patients with steroid hyperglycemia, glucose levels significantly increased (5,2 vs 8 mmol/L), but without significant correlation to mortality or number of hospital days. Stress hyperglycemia in non-diabetic patients with acute exacerbation of COPD is negative prognostic factor of intra-hospital outcome. This research acquired new knowledge about impact of stress hyperglycemia on outcome of AECOPD and hopefully will stimulate further studies about stricter glycemic control that could possibly contribute to a better treatment outcome of these patients