The association between blood glucose levels and hospital outcomes in patients admitted with acute exacerbations of chronic obstructive pulmonary disease

Abstract

Patients with acute exacerbations of chronic obstructive pulmonary disease usually require an escalation in medical management and often require hospitalization.  The outcomes from these episodes depend on the severity of the underlying chronic lung disease, the degree of acute respiratory failure superimposed on the chronic lung disease, comorbidity, and possibly hospital related complications. Hyperglycemia represents an independent risk factor for hospital associated complications and/or mortality in other medical diagnoses, such as stroke and acute myocardial infarction.  Recent studies in patients with acute exacerbations of COPD demonstrate that hyperglycemia is associated with an increased length of hospital stay, failure of noninvasive ventilation, and/or mortality. Acute stress and medications used with an acute flare, such as glucocorticoids and beta agonists, increase blood glucose levels.   The explanation for poor outcomes likely involves an increase in colonization with pathogenic bacteria, acute changes in host defenses, and possibly metabolic disorders related to hyperglycemia and glycosuria.  Patients with acute stress and glucocorticoid related hyperglycemia often have higher blood glucose levels in the afternoon and early evening.  Consequently, this problem may be overlooked if clinicians depend on routine a.m. laboratory tests.  Therefore, patients with acute flares in COPD should have bedside point of care glucose measurements during the early course of their hospitalizations.  Patients with high glucose levels require nutritional management and/or insulin treatment.  We need more prospective studies to determine the degree of hyperglycemia in these patients, the acute consequences, and the best management strategies.