Andreas Vestergaard Jensen1,2, Gertrud Baunbæk Egelund1,2, Stine Bang Andersen1, Pelle Trier Petersen1, Thomas Benfield2,3, Martin Witzenrath4,5, Gernot Rohde5,6, Pernille Ravn2,7, Daniel Faurholt-Jepsen1. 1. Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital-Hillerød, Hillerød, Denmark. 2. University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark. 3. Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark. 4. Division of Pulmonary Inflammation, Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin, Berlin, Germany. 5. Community Acquired Pneumonia Competence Network-Stiftung, Hannover, Germany. 6. Department of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt/Main, Germany; and. 7. Medical Department O, Herlev and Gentofte Hospital, Copenhagen, Denmark.
Abstract
Rationale: 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. Objectives: We hypothesized that the glycemic gap (the difference between plasma glucose and the estimated average glucose) may be associated with mortality irrespective of DM. Methods: 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 A1c 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 post hoc analysis, the absolute and relative glycemic gaps were used as a categorical variable grouped according to quartiles. Results: In the post hoc 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.Conclusions: 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 post hoc analysis and should be validated in other populations before further conclusions can be made.
Rationale: 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. Objectives: We hypothesized that the glycemic gap (the difference between plasma glucose and the estimated average glucose) may be associated with mortality irrespective of DM. Methods: 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 A1c 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 post hoc analysis, the absolute and relative glycemic gaps were used as a categorical variable grouped according to quartiles. Results: In the post hoc 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.Conclusions: 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 post hoc analysis and should be validated in other populations before further conclusions can be made.
Authors: Clara L Clausen; Christian Leo-Hansen; Daniel Faurholt-Jepsen; Rikke Krogh-Madsen; Christian Ritz; Ole Kirk; Henrik L Jørgensen; Thomas Benfield; Thomas P Almdal; Ole Snorgaard Journal: Diabetes Res Clin Pract Date: 2022-04-25 Impact factor: 8.180
Authors: Sondre Serigstad; Christian Ritz; Daniel Faurholt-Jepsen; Dagfinn Markussen; Marit H Ebbesen; Øyvind Kommedal; Rune O Bjørneklett; Lars Heggelund; Tristan W Clark; Cornelis H van Werkhoven; Siri T Knoop; Elling Ulvestad; Harleen M S Grewal Journal: Trials Date: 2022-08-01 Impact factor: 2.728
Authors: Mathias W Pletz; Andreas Vestergaard Jensen; Christina Bahrs; Claudia Davenport; Jan Rupp; Martin Witzenrath; Grit Barten-Neiner; Martin Kolditz; Sabine Dettmer; James D Chalmers; Daiana Stolz; Norbert Suttorp; Stefano Aliberti; Wolfgang M Kuebler; Gernot Rohde Journal: Respir Res Date: 2022-09-10