Prevalence and determinants of hyperglycaemia in pneumonia patients

Abstract

Background: Hyperglycaemia during pneumonia prolongs the hospitalization and increases the risks of complications and death. However, its prevalence and determinants have not been systematically assessed. Methods: This was a prospective, cross-sectional study. The material consisted of 153 hospitalized patients with pneumonia. Patients needing intensive care unit treatment were excluded. The height, weight, waist circumference, oxygen saturation, blood pressure, temperature, heart rate, and Karnofsky score were measured at admission. Blood tests included glycosylated haemoglobin A1c (gHbA1c), C-reactive protein (CRP), leukocytes, urea, and arterial blood gas analysis. Plasma glucose was measured 7 times during the first day on the ward. Hyperglycaemia was defined as a fasting glucose > 7.0 mmol/l or postprandial glucose > 11.1 mmol/l. Results: Ninety-two patients (60%) showed hyperglycaemia. Twenty-two patients had a diagnosis of diabetes before hospitalization. Of the 131 patients without such a diagnosis, 72 (55%) showed hyperglycaemia. Of these, 67 showed fasting hyperglycaemia and 36 postprandial hyperglycaemia. In the binary logistic regression analysis, the following factors showed independent associations with the presence of hyperglycaemia: advanced age, high gHbA1c, high CRP, and high blood leukocyte level. Conclusions: More than half of non-diabetic patients with mild to moderate pneumonia demonstrated hyperglycaemia. The main determinants of hyperglycaemia were an abnormal pre-pneumonia glucose metabolism and the intensity of the pneumonic inflammation. Systematic screening of hyperglycaemia in all hospitalized pneumonia patients appears reasonable to identify high-risk patients.

Keywords::

• Pneumonia
• diabetes
• hyperglycaemia
• glucose metabolism
• stress hyperglycaemia

Acknowledgements

We thank all the nurses on the Respiratory Medicine Ward of the Unit of Medicine and Clinical Research, Kuopio University Hospital, for measuring the glucose values. The study was funded by the Hospital District of Northern Savo. In addition, the Finnish Anti-Tuberculosis Association Foundation and Pulmonary Foundation in Kuopio Area supported the study with grants.

Declaration of interest: There are no conflicts of interest.

The funding sources had no involvement in the study design, in the collection, analysis, or interpretation of data, in the writing of the report, or in the decision to submit the manuscript for publication.