The impact of hyperglycemia on community-acquired pneumonia: A retrospective cohort study

Abstract

Background: Hyperglycemia at hospital admission is common in community-acquired pneumonia (CAP) patients with and without diabetes mellitus (DM). Hyperglycemia and DM may be independent predictors of a severe clinical outcome of CAP. Objectives: To determine the impact of blood glucose at admission on the clinical course of CAP. Design: A multicenter retrospective cohort study. Setting: Three hospitals in the capital region of Denmark. Participants: 1318 adult CAP patients hospitalized from January 1st 2011 until June 30th 2012. Main outcome measures: The association between blood glucose and DM status and severe clinical outcome was analyzed by logistic regression. Severe clinical outcome was defined as intensive care unit (ICU) admittance and in-hospital mortality. Models were adjusted for severity markers (CURB-65 score) and comorbidities. Results: 12.3% (162/1318) had pre-existing DM. Patients with DM had overall higher blood glucose on admission.Elevated blood glucose was, in patients without DM, associated with an increased risk for ICU admittance (adjusted OR 1.25 (95% CI1.13-1.39) and borderline, but not significantly associated with in-hospital mortality (adjusted OR 1.10 (95% CI0.99-1.23). In contrast, hyperglycemia in patients with DM was not associated with ICU admittance (adjusted OR 1.62 (0.93-2.82) or in-hospital mortality (adjusted OR 0.92 (0.47-1.79). DM was not associated with ICU admittance or in-hospital mortality. Conclusion: Increased blood glucose was, only in patients without DM, associated with a higher risk for ICU admittance and a trend towards higher in-hospital mortality. DM was not associated with a more severe outcome of CAP.