Department of Public Health Sciences, School of Public Health, University of Alberta, 13-103 Clinical Sciences Bldg, Edmonton T6G 2G3 AB, Canada.
Diabetologia. 2010 Mar;53(3):497-503. doi: 10.1007/s00125-009-1598-y. Epub 2009 Nov 20.
AIMS/HYPOTHESIS: The aim of this study was to investigate whether dysglycaemia at admission is associated with adverse events at 90 days or 1 year in a population-based cohort of patients hospitalised with community-acquired pneumonia (CAP).
Clinical and laboratory data were prospectively collected on all 2,366 adults without diabetes admitted with CAP to six hospitals in Edmonton (AB, Canada) and grouped according to admission glucose: 4.0 to <6.1 mmol/l(n=778, reference group), 6.1 to <7.8 mmol/l (n=924); 7.8 to<11.1 mmol/l (n=535); and 11.1 to 20 mmol/l (n=129). Multivariable Cox models were used to examine the relationship between dysglycaemia and mortality or CAP readmission during follow-up.
The mean age was 69 (SD 18) years and 48% of participants were female. Compared with those with glucose <6.1 mmol/l (114 [15%] deaths), no differences in 90 day mortality were observed in the dysglycaemia groups: 143 deaths (15%) in the 6.1-7.8 mmol/l group (adjusted HR [aHR] 0.92, 95% CI 0.72-1.18), 111 deaths (21%) in the 7.8-11.1 mmol/l group (aHR 1.05, 0.81-1.37)and 34 deaths (26%) in the 11.1-20 mmol/l group (aHR 1.30, 0.88-1.93). Similarly, compared with those in the <6.1 mmol/l group (198 [25%] deaths), no difference in 1 year mortality was observed: 233 deaths (25%) in the 6.1 to <7.8 mmol/l group (aHR 0.86, 0.71-1.04), 164 deaths (31%) in the 7.8 to <11.1 mmol/l group (aHR 0.92, 0.75-1.14) and 49 deaths (38%) in the 11.1 to 20 mmol/l group (aHR 1.12, 0.81-1.55). Readmissions for CAP were also similar at 1 year: compared with 10% (70/707) in the 6.1 mmol/l group, the frequencies were 8% (66/842), 9% (45/474) and 10% (11/107) in the 6.1 to <7.8 mmol/l, 7.8 to <11.1 mmol/l, and 11.1 to 20 mmol/l groups, respectively (p>0.05 for all comparisons).
CONCLUSIONS/INTERPRETATION: Although previously associated with inpatient morbidity and mortality, admission dysglycaemia was not associated with an increased risk of death or CAP readmission at 90 days or 1 year among those who survived hospitalisation for pneumonia.
目的/假设：本研究旨在探讨在因社区获得性肺炎（CAP）住院的患者中，入院时的糖代谢异常与 90 天或 1 年时的不良事件是否相关。
前瞻性收集了所有 2366 名无糖尿病的成年人的临床和实验室数据，这些成年人因 CAP 入住埃德蒙顿（加拿大 AB 省）的六家医院，并根据入院时的血糖进行分组：4.0 至<6.1mmol/l（n=778，参考组）、6.1 至<7.8mmol/l（n=924）、7.8 至<11.1mmol/l（n=535）和 11.1 至 20mmol/l（n=129）。使用多变量 Cox 模型来检查糖代谢异常与随访期间的死亡率或 CAP 再入院之间的关系。
平均年龄为 69（SD 18）岁，48%的参与者为女性。与血糖<6.1mmol/l（114 [15%]例死亡）相比，在糖代谢异常组中，90 天死亡率无差异：6.1-7.8mmol/l 组 143 例死亡（15%）（调整 HR[aHR]0.92，95%CI0.72-1.18），7.8-11.1mmol/l 组 111 例死亡（21%）（aHR 1.05，0.81-1.37），11.1-20mmol/l 组 34 例死亡（26%）（aHR 1.30，0.88-1.93）。同样，与血糖<6.1mmol/l 组（198 [25%]例死亡）相比，1 年死亡率无差异：6.1 至<7.8mmol/l 组 233 例死亡（25%）（aHR 0.86，0.71-1.04），7.8 至<11.1mmol/l 组 164 例死亡（31%）（aHR 0.92，0.75-1.14），11.1-20mmol/l 组 49 例死亡（38%）（aHR 1.12，0.81-1.55）。CAP 的再入院率在 1 年内也相似：与 6.1mmol/l 组的 10%（70/707）相比，6.1 至<7.8mmol/l、7.8 至<11.1mmol/l 和 11.1 至 20mmol/l 组的频率分别为 8%（66/842）、9%（45/474）和 10%（11/107）（所有比较的 p>0.05）。
结论/解释：尽管先前与住院期间的发病率和死亡率相关，但在因肺炎住院存活的患者中，入院时的糖代谢异常与 90 天或 1 年时的死亡或 CAP 再入院风险增加无关。
