Extract
Diabetes mellitus increases the risk of and mortality associated with community-acquired pneumonia (CAP) [1]. Hyperglycaemia negatively impacts both the innate and adaptive immune response, which could lead to decreased bacterial clearance and increased mortality from infection [2]. This can be extended to non-diabetic patients as well: hyperglycaemia on admission is an independent risk factor for higher complication rates, longer length of stay, and higher mortality in diabetics and non-diabetics with CAP [3–6]. Hypoglycaemia on admission has also been associated with an independent increased risk of mortality in patients with CAP [7, 8]. Currently, two severity scoring systems are widely used for predicting CAP mortality: the pneumonia severity index (PSI) and CURB-65 score (confusion, urea >7 mmol·L−1, respiratory rate ≥30 breaths·min−1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years) [5, 9]. Admission glucose levels (AGL) are part of the PSI, as a categorical variable for hyperglycaemia, but not of CURB-65. We, therefore, investigated whether AGL contributes to these severity scores when both hypo- and hyperglycaemic states are appropriately modelled.
Abstract
Admission glucose levels do not improve discrimination of current severity scores in community-acquired pneumonia http://ow.ly/Dyrz30f7Bwi
Acknowledgements
We would like to thank the members of the CAP-START study group for securing the conduct of the study in all participating hospitals. Additional thanks to Tim P. Morris, MRC Clinical Trials Unit at University College London, for his guidance on applying fractional polynomial estimation and selection in a multiple imputation context.
Footnotes
Support statement: Supported by a grant (171202002) from the Netherlands Organization for Health Research and Development. Funding information for this article has been deposited with the Crossref Funder Registry.
Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com
- Received May 19, 2016.
- Accepted July 21, 2017.
- Copyright ©ERS 2017