Blood glucose level and outcomes in COPD Exacerbations

Abstract

Introduction: Hyperglycemia is associated with acute exacerbation of COPD (AECOPD) and is associated with poor outcome. Thus present study was carried out with an aim to determine the association of blood glucose level on the outcome of patients with Acute Exacerbation of COPD. Methodology:This was a prospective observational study conducted on hundred patients admitted with the diagnosis of AECOPD at a tertiary care hospital in central India from December 2018 and May 2020. Patients were grouped on the basis of mean capillary glucose level into four quartiles: Group A <110 mg/dl; Group B 110-125 mg/dl; Group C >125-160 mg/dl; Group D >160 mg/dl. Severity of AECOPD was assessed in each of the four quartiles. Diabetics were excluded. Data was analysed using SPSS 25 and chi square test was applied to know the statistical significance.Results:A positive correlation of mean blood glucose level wasseen with increasing severity of AECOPD (r2=0.402; p=0.001). Majority of the patients with blood glucose greater than 160 mg/dl had severe (75%) to life exacerbation episodes (12.5%). Patients with mean blood glucose level 126 to 160 mg/dl and >160 mg/dl had significantly longer LOHS of greater than 9 days in 67.4% and 87.5% respectively. Gram negative bacilli (34% and 25%) were isolated two times more frequently than gram positive bacteria at higher mean blood glucose level (p<0.001).Higher mean blood glucose level (>126 mg/dl), as opposed to lower mean blood glucose level (< 126 mg/dl), was more likely to be associated with bacterial infection as a cause of COPD exacerbation.Conclusion:Short term hyperglycaemia during hospital stay, in the absence of pre-existing diabetes, can have adverse outcomes in AECOPD. Higher mean blood glucose level was associated with adverse outcome with respect to severity of exacerbation of COPD, LOHS and higher rate of bacterial exacerbations. However, no association was found between increased mean blood glucose and 30 day hospital readmission and mortality.