High Glucose Levels Identify Patients at Risk for Pneumonia Death

Of the 7,400 patients originally included in the cohort, 509 were excluded due to missing information on death. The remaining 6,891 patients from 12 clinical centers throughout Germany were analyzed (mean age, 59.8 years).

Within 28 days, 324 (4.7%) patients died, an additional 514 (7.5%) died within 90 days, and 648 (9.4%) patients died within 180 days.

"Patients with increased serum glucose levels on admission were more likely to die within the first 28 days after admission than those with normal serum glucose levels (adjusted P for trend <.001.)," researchers wrote.

Results indicated that patients with mild acute hyperglycemia had a heightened risk for death at 90 days when compared with those with normal glucose levels (HR=1.56; 95% CI, 1.22-2.01) -- a risk that increased significantly when serum glucose concentrations were 14 mmol/L or higher (HR=2.37; 95% CI, 1.62-3.46).

"In the past, stress hyperglycemia was often thought to be a useful adaptive response, glucose being a ready source of fuel for brain, skeletal muscle, heart and other organs at a time of increased metabolic demand," the researchers wrote. "Our results show that hyperglycemia on admission in patients with community-acquired pneumonia is associated with an adverse outcome and predicts mortality."

Additionally, overall mortality on days 28, 90 and 180 was significantly higher in patients with pre-existing diabetes compared with patients without diabetes (day 90: 14.5% vs. 6.1%; crude HR=2.47; 95% CI, 2.05-2.98). Patients without diabetes and low glucose levels were not associated with mortality.

However, there were several limitations within the study, including difficulty identifying patients with undiagnosed diabetes and those with stress-induced hyperglycemia.

"Oral glucose tolerance test and close glucose monitoring after discharge are necessary to diagnose overt diabetes and to prevent subacute or long-term complications," researchers concluded.

They said large-scale trials are needed to determine whether drug intervention is a suitable method in reducing mortality in patients with community-acquired pneumonia.

Lepper PM. BMJ. 2012;doi:10.1136/bmj.e3397.