Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Am J Med. 2010 Jun;123(6):556.e11-6. doi: 10.1016/j.amjmed.2009.11.021.
The relationship between spontaneous admission hypoglycemia and mortality in patients hospitalized with community-acquired pneumonia is unclear.
From 2000 to 2002, clinical data were prospectively collected on all patients with community-acquired pneumonia who were admitted to all 6 hospitals in Edmonton, Alberta, Canada. Patients with admission glucose greater than 6.1 mmol/L (n=1996) were excluded; the remaining patients were categorized as having admission hypoglycemia (<4.0 mmol/L [n=54]) or normoglycemia (4.0 to< or =6.1 mmol/L [n=902]). Multivariable Cox proportional hazards models were used to examine the relationship between hypoglycemia and all-cause mortality in-hospital, at 30 days, and at 1 year.
The mean age was 65 (standard deviation=20) years, 48% were female, 8% had diabetes, and 56% had severe pneumonia. Overall, admission hypoglycemia was present in 2% (54/2990) of the entire cohort and 6% of those with glucose of 6.1 mmol/L or less. Total deaths were 89 (9%) in-hospital, 96 (10%) at 30 days, and 247 (26%) at 1 year. In-hospital mortality was higher among patients with admission hypoglycemia (11 [20%] deaths) compared with those with normoglycemia (78 [9%]; adjusted hazards ratio [aHR] 2.96; 95% confidence interval [CI], 1.39-6.31; P=.005). An increased risk of mortality was observed at 30 days (11 [20%] vs 85 [10%]; aHR 2.89; 95% CI, 1.32-6.29) and remained elevated at 1 year (19 [35%] vs 228 [25%]; aHR1.80; 95% CI, 1.02-3.17). These results were not influenced by treatment for diabetes (P>.4 for interaction).
In a population-based sample of patients with community-acquired pneumonia, spontaneous admission hypoglycemia was independently associated with increased mortality during hospitalization that persisted to 1 year. Patients with hypoglycemia are an easily identified group that may warrant more intensive inpatient and postdischarge follow-up.
自发性入院低血糖与社区获得性肺炎患者的死亡率之间的关系尚不清楚。
2000 年至 2002 年，前瞻性地收集了所有在加拿大艾伯塔省埃德蒙顿市 6 家医院住院的社区获得性肺炎患者的临床数据。排除入院血糖大于 6.1mmol/L 的患者（n=1996）；将其余患者分为入院时低血糖（<4.0mmol/L[n=54]）或血糖正常（4.0 至<6.1mmol/L[n=902]）。采用多变量 Cox 比例风险模型来检查低血糖与院内全因死亡率、30 天死亡率和 1 年死亡率之间的关系。
整个队列的平均年龄为 65 岁（标准差为 20 岁），48%为女性，8%患有糖尿病，56%患有严重肺炎。总体而言，入院时低血糖的发生率为 2%（54/2990），血糖为 6.1mmol/L 或更低的患者中低血糖的发生率为 6%。院内总死亡人数为 89（9%），30 天内死亡人数为 96（10%），1 年内死亡人数为 247（26%）。入院时低血糖患者的院内死亡率（11[20%]例死亡）高于血糖正常患者（78[9%]；校正后的危险比[aHR]2.96；95%置信区间[CI]1.39-6.31；P=.005）。在 30 天时观察到死亡率增加（11[20%]例死亡 vs 85[10%]例死亡；aHR2.89；95%CI，1.32-6.29），1 年后仍保持升高（19[35%]例死亡 vs 228[25%]例死亡；aHR1.80；95%CI，1.02-3.17）。这些结果不受糖尿病治疗的影响（交互作用 P>.4）。
在一项以社区获得性肺炎患者为基础的样本中，自发性入院低血糖与住院期间的死亡率增加独立相关，且这种相关性持续至 1 年。低血糖患者是一个易于识别的群体，可能需要更强化的住院和出院后随访。
