Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital-Hillerød, Hillerød, Denmark.
University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark.
Ann Am Thorac Soc. 2019 Dec;16(12):1518-1526. doi: 10.1513/AnnalsATS.201901-007OC.
Hyperglycemia is associated with mortality in patients with community-acquired pneumonia (CAP), and hyperglycemia may be a biomarker of severity. However, hyperglycemia has a major disadvantage because the association is diminished in patients with diabetes mellitus (DM). This hampers the use of hyperglycemia as a biomarker. Accounting for habitual glucose levels could overcome this disadvantage. We hypothesized that the glycemic gap (the difference between plasma glucose and the estimated average glucose) may be associated with mortality irrespective of DM. Among 1,933 adults with CAP included in a prospective multicenter cohort, we investigated the association between the glycemic gap and 90-day mortality. Hemoglobin A was used to estimate the average glucose. The association was assessed with Cox proportional hazard models after adjustment for age, sex, CURB-65 (Confusion, urea >7 mmol/L, respiratory rate ≥30 breaths/minute, systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg and age ≥65 years), and comorbidities. In the prespecified analysis the absolute and relative glycemic gaps were used as a continuous variable. In a analysis, the absolute and relative glycemic gaps were used as a categorical variable grouped according to quartiles. In the analysis, patients with the lowest (negative) and highest (positive) absolute glycemic gap quartiles had increased risk of 90-day mortality (hazard ratio, 2.6; 95% confidence interval, 1.02-6.65; and hazard ratio, 2.5; 95% confidence interval, 1.01-6.06, respectively). A similar association was found for the relative glycemic gap. The associations were independent of age, CURB-65 score, sex, or number of comorbidities and not modified by DM. Patients with the highest and lowest glycemic gap may have an increased risk of 90-day mortality, and the association was not modified by DM. These associations were found in an exploratory analysis and should be validated in other populations before further conclusions can be made.
高血糖与社区获得性肺炎（CAP）患者的死亡率相关，高血糖可能是严重程度的生物标志物。然而，高血糖有一个主要的缺点，因为在糖尿病患者中，这种关联减弱了。这阻碍了将高血糖用作生物标志物。考虑到习惯性血糖水平可以克服这一缺点。我们假设血糖差距（血浆葡萄糖与估计平均葡萄糖之间的差异）可能与死亡率相关，而与糖尿病无关。在一项前瞻性多中心队列的 1933 名 CAP 成年人中，我们研究了血糖差距与 90 天死亡率之间的关系。血红蛋白 A 用于估计平均血糖。在调整年龄、性别、CURB-65（意识障碍、尿素 >7mmol/L、呼吸频率≥30 次/分钟、收缩压<90mmHg 或舒张压≤60mmHg 和年龄≥65 岁）和合并症后，使用 Cox 比例风险模型评估相关性。在预先指定的分析中，绝对和相对血糖差距被用作连续变量。在 分析中，绝对和相对血糖差距被用作按四分位数分组的分类变量。在 分析中，绝对血糖差距最低（负值）和最高（正值）四分位数的患者 90 天死亡率风险增加（风险比，2.6；95%置信区间，1.02-6.65；风险比，2.5；95%置信区间，1.01-6.06）。相对血糖差距也存在类似的关联。这些关联独立于年龄、CURB-65 评分、性别或合并症数量，并且不受糖尿病的影响。血糖差距最高和最低的患者 90 天死亡率风险可能增加，而这种关联不受糖尿病的影响。这些关联是在探索性分析中发现的，在得出进一步结论之前，需要在其他人群中进行验证。
