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The Glycemic Gap and 90-Day Mortality in Community-acquired Pneumonia: A Prospective Cohort Study

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German Community-Acquired Pneumonia Competence Network (CAPNETZ). / The Glycemic Gap and 90-Day Mortality in Community-acquired Pneumonia : A Prospective Cohort Study. In: Annals of the American Thoracic Society. 2019 ; Vol. 16, No. 12. pp. 1518-1526.

Bibtex

@article{545c78abb202404ba7bb2516bf43e3f0,
title = "The Glycemic Gap and 90-Day Mortality in Community-acquired Pneumonia: A Prospective Cohort Study",
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 since 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 1933 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, gender, CURB-65 and comorbidities. In the prespecified analysis the absolute and the relative glycemic gap were used as a continuous variable. In an post-hoc analysis the absolute and the relative glycemic gap 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 (HR 2.6 (95{\%} CI 1.02-6.65) and 2.5 (95{\%} CI 1.01-6.06)), respectively. A similar association was found for the relative glycemic gap. The associations were independent of age, CURB-65 score, gender or number of comorbidities and not modified by DM.CONCLUSION: 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.",
author = "Jensen, {Andreas Vestergaard} and {Baunb{\ae}k Egelund}, Gertrud and {Bang Andersen}, Stine and Petersen, {Pelle Trier} and Thomas Benfield and Martin Witzenrath and Gernot Rohde and Pernille Ravn and Daniel Faurholt-Jepsen and {German Community-Acquired Pneumonia Competence Network (CAPNETZ)}",
year = "2019",
month = "12",
doi = "10.1513/AnnalsATS.201901-007OC",
language = "English",
volume = "16",
pages = "1518--1526",
journal = "Annals of the American Thoracic Society",
issn = "2325-6621",
publisher = "American Thoracic Society",
number = "12",

}

RIS

TY - JOUR

T1 - The Glycemic Gap and 90-Day Mortality in Community-acquired Pneumonia

T2 - A Prospective Cohort Study

AU - Jensen, Andreas Vestergaard

AU - Baunbæk Egelund, Gertrud

AU - Bang Andersen, Stine

AU - Petersen, Pelle Trier

AU - Benfield, Thomas

AU - Witzenrath, Martin

AU - Rohde, Gernot

AU - Ravn, Pernille

AU - Faurholt-Jepsen, Daniel

AU - German Community-Acquired Pneumonia Competence Network (CAPNETZ)

PY - 2019/12

Y1 - 2019/12

N2 - 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 since 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 1933 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, gender, CURB-65 and comorbidities. In the prespecified analysis the absolute and the relative glycemic gap were used as a continuous variable. In an post-hoc analysis the absolute and the relative glycemic gap 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 (HR 2.6 (95% CI 1.02-6.65) and 2.5 (95% CI 1.01-6.06)), respectively. A similar association was found for the relative glycemic gap. The associations were independent of age, CURB-65 score, gender or number of comorbidities and not modified by DM.CONCLUSION: 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.

AB - 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 since 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 1933 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, gender, CURB-65 and comorbidities. In the prespecified analysis the absolute and the relative glycemic gap were used as a continuous variable. In an post-hoc analysis the absolute and the relative glycemic gap 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 (HR 2.6 (95% CI 1.02-6.65) and 2.5 (95% CI 1.01-6.06)), respectively. A similar association was found for the relative glycemic gap. The associations were independent of age, CURB-65 score, gender or number of comorbidities and not modified by DM.CONCLUSION: 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.

UR - http://www.scopus.com/inward/record.url?scp=85075812782&partnerID=8YFLogxK

U2 - 10.1513/AnnalsATS.201901-007OC

DO - 10.1513/AnnalsATS.201901-007OC

M3 - Journal article

VL - 16

SP - 1518

EP - 1526

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

IS - 12

ER -

ID: 57846269