Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease

• Published in: International journal of chronic obstructive pulmonary disease Vol. 12; pp. 1923 - 1932
• Main Authors: Yang, Chih-Jen, Liao, Wen-I, Tang, Zun-Cheng, Wang, Jen-Chun, Lee, Chien-Hsing, Chang, Wei-Chou, Hsu, Chin-Wang, Tang, Shih-En, Tsai, Shih-Hung
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Ltd 01.01.2017; Dove Medical Press
• Subjects: acute respiratory failure; Adrenal Cortex Hormones - therapeutic use; Aged; Aged, 80 and over; Biomarkers - blood; Blood Glucose - metabolism; Chronic obstructive pulmonary disease; Classification; Diabetes; diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - diagnosis; Disease Progression; Dyspnea; Female; Glucose; glycated hemoglobin; Glycated Hemoglobin A - metabolism; glycemic gap; Hemoglobin; Hospitals; Humans; Hyperglycemia; Hyperglycemia - blood; Hyperglycemia - complications; Hyperglycemia - diagnosis; Hypoglycemia; Illnesses; Infections; Laboratories; Lung - drug effects; Lung - physiopathology; Lung diseases; Male; Medical records; Middle Aged; Original Research; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Regression analysis; Retrospective Studies; Risk Factors; Software; stress hyperglycemia ratio; Ventilation; United States > US; hyperglycemia; stress hyperglycemia ratio; acute respiratory failure; glycated hemoglobin; glycemic gap; diabetes mellitus; chronic obstructive pulmonary disease
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S131232

Acute hyperglycemia is a common finding in patients presenting to emergency departments (EDs) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Several studies have argued against the association between hyperglycemia at admission and adverse outcomes in patients with diabetes and an acute illness. Recent studies have shown that glucose-related variables (eg, glycemic gaps and stress hyperglycemia ratios) that are adjusted for glycated hemoglobin levels can indicate the severity of a variety of diseases. The objective of this study was to assess whether these hemoglobin A1c (HbA1c)-based adjusted average glycemic variables were associated with unfavorable outcomes in patients admitted to a hospital with AECOPD. We found that 1) pulmonary infection is a major risk factor for AECOPD; 2) a higher glycemic gap and modified stress hyperglycemia ratio were associated with the development of acute respiratory failure (ARF) in patients with diabetes admitted to an ED because of AECOPD; and 3) the glycemic gap and modified stress hyperglycemia ratio had superior discriminative power over acute hyperglycemia and HbA1c for predicting the development of ARF, although the HbA1c-adjusted glycemic variables alone were not independent risk factors for ARF.