Glicemia, NAC y muerte

Serum glucose levels for predicting death in patients admitted to hospital for community acquired pneumonia: prospective cohort study

BMJ 2012;344:e3397

Abstract

Objective

To examine whether acute dysglycaemia predicts death in people admitted to hospital with community acquired pneumonia.

Design

Multicentre prospective cohort study.

Setting

Hospitals and private practices in Germany, Switzerland, and Austria.

Participants

 6891 patients with community acquired pneumonia included in the German community acquired pneumonia competence network (CAPNETZ) study between 2003 and 2009.

Main outcome measures

 Univariable and multivariable hazard ratios adjusted for sex, age, current smoking status, severity of community acquired pneumonia using the CRB-65 score (confusion, respiratory rate >30/min, systolic blood pressure ≤90 mm Hg or diastolic blood pressure ≤60 mm Hg, and age ≥65 years), and various comorbidities for death at 28, 90, and 180 days according to serum glucose levels on admission.

Results

An increased serum glucose level at admission to hospital in participants with community acquired pneumonia and no pre-existing diabetes was a predictor of death at 28 and 90 days. Compared with participants with normal serum glucose levels on admission, those with mild acute hyperglycaemia (serum glucose concentration 6-10.99 mmol/L) had a significantly increased risk of death at 90 days (1.56, 95% confidence interval 1.22 to 2.01; P<0.001), and this risk increased to 2.37 (1.62 to 3.46; P<0.001) when serum glucose concentrations were ≥14 mmol/L. In sensitivity analyses the predictive value of serum glucose levels on admission for death was confirmed at 28 days and 90 days. Patients with pre-existing diabetes had a significantly increased overall mortality compared with those without diabetes (crude hazard ratio 2.47, 95% confidence interval 2.05 to 2.98; P<0.001). This outcome was not significantly affected by serum glucose levels on admission (P=0.18 for interaction).

Conclusions

Serum glucose levels on admission to hospital can predict death in patients with community acquired pneumonia without pre-existing diabetes. Acute hyperglycaemia may therefore identify patients in need of intensified care to reduce the risk of death from community acquired pneumonia.

Mi  comentario

Este estudio viene a reforzar los datos que nos indican que los pacientes que tienen glicemias elevadas al tener una enfermedad aguda, tienen peor pronóstico que los pacientes con glicemias normales y me parece que ello se debe a que estos pacientes son prediabeticos o tienen SM y por lo tanto, son pacientes que están en un estado inflamatorio agudo y ello se asocia a más altas tasas de mortalidad.  Por otro lado el índice pronóstico CURB 65 no evalúa glicemia a diferencia del PSI (pneumonia severity index), por lo que me parecería interesante y lo dejo a los investigadores comparar ambos indices en pacientes con y sin glicemia alta al ingreso y ver cuál de los dos se asocia a peor pronóstico y ello nos ayudaría a usar el más adecuado en los pacientes con sospecha clínica de SM, que serían aquellos pacientes con CA     ( cintura abdominal ) alta...