Utjecaj stresne hiperglikemije na bolnički ishod akutne egzacerbacije kronične opstruktivne plućne bolesti [Impact of stress hyperglycemia on hospital outcome of acute exacerbation of chronic oobstructive pulmonary disease]

Marković, Marija (2020) Utjecaj stresne hiperglikemije na bolnički ishod akutne egzacerbacije kronične opstruktivne plućne bolesti [Impact of stress hyperglycemia on hospital outcome of acute exacerbation of chronic oobstructive pulmonary disease]. PhD thesis, Sveučilište u Zagrebu.

PDF Download (3MB)

Abstract

Impact of stress hyperglycemia on outcomes from acute exacerbations of COPD (AECOPD) has not been established. The aim of the research is to determine the impact of stress hyperglycemia (blood glucose > 6,9 and 7,8 mmol/L postprandial) on intrahospital mortality, length of hospitalization and specific clinical parameters. We enrolled 272 non-diabetics hospitalized in General Hospital Zabok for AECOPD in one year period and divide them in 2 groups according to glucose levels in venous plasma at admission. After corticosteroid therapy each group was further stratified according to glycemia after 24 hours and before discharge. Beside main aims, we evaluated impact on lung function changes, CRP level, sputum culture, the presence of radiological pneumonia and need for mechanical ventilation. Results showed that 113 patients (41,5%) had stress hyperglycemia at admission and statistically significant higher average glucose levels (9,7 vs 5,7 mmol/l). Fatal outcome happened in 8,1 % cases and it was three times more often between patients with stress hyperglycemia (13,3 % vs 4,4%), independent of age, sex, FEV1 and COPD severity or duration . The relative risk (RR) of death or long inpatient stay was significantly increased in patients with stress hyperglycemia. For each 1 mmol/L increase in blood glucose the absolute risk of adverse outcome increased by 1,23 (95% CI. 1,04 to 1,46, p =0,015). Glucose levels at admission were much higher in non-survivors than survivors (9,65 vs 6,35 mmol/L). Length of hospital stay was longer in patients with stress hyperglycemia (9 vs 7 days, p= 0,001), so was the incidence of pneumonia (29,2% vs 10,1%, p<0,001). In patients with steroid hyperglycemia, glucose levels significantly increased (5,2 vs 8 mmol/L), but without significant correlation to mortality or number of hospital days. Stress hyperglycemia in non-diabetic patients with acute exacerbation of COPD is negative prognostic factor of intra-hospital outcome. This research acquired new knowledge about impact of stress hyperglycemia on outcome of AECOPD and hopefully will stimulate further studies about stricter glycemic control that could possibly contribute to a better treatment outcome of these patients.

Abstract in Croatian

Utjecaj stresne hiperglikemije na ishod akutne egzacerbacije KOPB-a nije poznat. Cilj ovog istraživanja je utvrđivanje utjecaja stresne hiperglikemije (GUK > 6,9 natašte, tj. 7,8 mmol/L postprandijalno) na intrahospitalni mortalitet, dužinu hospitalizacije i specifične kliničke parametre. Uključena su 272 nedijabetičara hospitalizirana u OB Zabok zbog egzacerbacije KOPB-a u jednogodišnjem periodu koji su podjeljeni u 2 skupine prema vrijednosti glukoze kod prijema. Nakon kortikosteroidne terapije dodatno su stratificirani prema vrijednostima glikemije nakon 24 sata i kod otpusta. Rezultati su pokazali kako je 113 bolesnika (41,5%) imalo stresnu hiperglikemiju kod prijema i značajno više prosječne vrijednosti glikemije od kontrolne skupine (9,7 vs 5,7 mmol/l). Smrtni ishod zabilježen je u 8,1% slučajeva (N=22), i to tri puta češće među ispitanicima sa stresnom hiperglikemijom (13,3% vs 4,4%), bez obzira na dob, spol, FEV1, težinu i trajanje KOPB-a. Među socio-demografskim i kliničkim kategorijskim varijablama, između ispitivane i kontrolne skupine, jedina statistički značajna razlika je bila u potrebi za mehaničkom ventilacijom ( 22,7% vs 4,0 %). Glikemija kod prijema je bila značajno veća u skupini ispitanika sa smrtnim ishodom (9,65 vs 6,35 mmol/L). Ovo je istraživanje pokazalo kako jedinično povećanje koncentracije glukoze pri prijemu povećava rizik smrtnog ishoda za 1,23 puta . Kod ispitanika koji su razvili steroidnu hiperglikemiju razine GUK-a bile su značajno veće nakon primjene kortikosteroidne terapije: 5,20 mmol/L (3,5 - 7 mmol/L) vs 8,0 mmol/L (7,2 - 10,3mmol/L), ali bez utjecaja na intrahospitalni mortalitet ili dužinu liječenja. Trajanje bolničkog liječenja je bilo statistički značajno dulje u ispitanika sa stresnom hiperglikemijom (9 vs 7 dana). Rezultati ovog istraživanja doprinijeti će boljem razumjevanju utjecaja stresne hiperglikemije na ishod egzacerbacije KOPB-a, obuhvatili su nedostatke ranijih studija i trebaju stimulirati daljnja istraživanja o mogućnosti poboljšavanja ishoda strožom kontrolom glikemije što bi bilo od velikog kliničkog i javnozdravstvenog značaja.

Actions (login required)

View Item

Downloads