Impact of Admission Hyperglycemia on Outcome in Patients with Acute Respiratory Failure Due to COPD Exacerbation

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 818-841-Diabetes Pathophysiology & Complications
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-834
Danae Delivanis*1, Pooja Luthra1, N Burki1, Richard L ZuWallack2 and D Datta1
1University of CT Health Center, Farmington, CT, 2St Francis Hospital, Hartford, CT
Background:Elevated blood glucose is a common pathophysiological response to acute illness and has been reported in patients with acute exacerbation of COPD (AECOPD). This hyperglycemia may be caused by underlying diabetes mellitus (DM) or chronic steroid use and by the physiological stress of acute illness. Hyperglycemia is associated with poor outcomes in many acute illnesses including AECOPD but its impact on acute respiratory failure due to AECOPD has not been studied.

Objective: (i) Evaluate the incidence of hyperglycemia (blood glucose>180 mg%) on ICU admission in patients with AECOPD with acute respiratory failure (ii)To determine the effect of admission hyperglycemia on ICU length of stay (ICULOS) and hospital length of stay(HospLOS) and its association with adverse events (sepsis and death) in these patients.

Methods:  Patients admitted to the ICU with AECOPD causing acute respiratory failure were retrospectively studied. Patient demographics, number of patients on chronic steroids and with DM were obtained. Hyperglycemia was defined as admission blood glucose (B.glucose) >180mg%. Patients with B.glucose >180 mg% were labeled as hyperglycemic while those with B.glucose<180 mg% were labeled non-hyperglycemic. Outcomes measured included ICU LOS, HospLOS and occurrence of sepsis and deaths. Univariate analysis was performed to determine the effect of B.glucose > 180mg% on outcomes. Paired t-test was performed to determine the difference in these outcomes between the hyperglycemic and non-hyperglycemic patients. p<0.05 was deemed statistically significant.

Results: Of 75 patients studied, 46% were males; mean age was 72.4±11.2 years. Mean B.glucose was 156±73 mg%. Fifteen patients (20%) had hyperglycemia at admission; of these,13 had DM and 1 was on chronic steroids. Of the 60 patients with B. glucose< 180mg%, 24 had DM and 11 were on chronic steroids. Mean B.glucose was 255 ±118 mg% in hyperglycemic group and 132±27mg% in the non-hyperglycemic group (p=0.0002). ICU LOS in hyperglycemic patients was 5.1± 6 days versus 2.9±2.7days in non-hyperglycemic patients (p = 0.04) which was statistically significant. Hospital LOS was 10.5± 8 days in hyperglycemic patients and 8±5 days in non-hyperglycemic patients (p = 0.15). Sepsis was present in 6 of the hyperglycemic patients and 16 of the non-hyperglycemic patients (p=0.31). 2 deaths occurred in each of the 2 groups respectively (p=0.12).

Conclusions: Hyperglycemia, defined as blood glucose>180 mg %, occurs commonly in acute respiratory failure due to COPD exacerbation and appears to be an indicator of severity of illness and poor outcome. It is associated with increased ICULOS but not with increased HospLOS, increased incidence of sepsis and death. Further studies are needed to confirm these findings and determine if better glycemic control results in shorter ICULOS in these patients.

Nothing to Disclose: DD, PL, NB, RLZ, DD

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