Rayos

Elevated Admission Glucose and Mortality in Patients With Acute Pulmonary Embolism
1. Nathalie Scherz, MD1⇓, 
2. José Labarère, MD2, 
3. Drahomir Aujesky, MD, MSC1 and 
4. Marie Méan, MD1
+Author Affiliations
1. 1Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
2. 2Techniques de l’Ingénierie Médicale et de la Complexité, UMR 5525 CentreNational de la Recherche Scientifique, Université Joseph Fourier-Grenoble 1, Grenoble, France
1. Corresponding author: Nathalie Scherz, nathalie.scherz@insel.ch.
 
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Abstract
OBJECTIVE Although associated with adverse outcomes in other cardiopulmonary conditions, the prognostic value of elevated glucose in patients with acutepulmonary embolism (PE) is unknown. We sought to examine the association between glucose levels and mortality and hospital readmission rates for patients with PE.
RESEARCH DESIGN AND METHODS We evaluated 13,621 patient discharges with a primary diagnosis of PE from 185 acute care hospitals in Pennsylvania (from January 2000 to November 2002). Admission glucose levels were analyzed as a categoricalvariable (≤110, >110–140, >140–170, >170–240, and >240 mg/dL). The outcomes were 30-day all-cause mortality and hospital readmission. We used random-intercept logistic regression to assess the independent association between admission glucose levels and mortality and hospital readmission, adjusting for patient (age, sex, race, insurance, comorbid conditions, severity of illness,laboratory parameters, and thrombolysis) and hospital (region, size, and teaching status) factors.
RESULTS Elevated glucose (>110 mg/dL) was present in 8,666 (63.6%) patients. Patients with a glucose level ≤110, >110–140, >140–170, >170–240, and >240 mg/dL had a 30-day mortality of 5.6, 8.4, 12.0, 15.6, and 18.3%, respectively (P < 0.001). Compared with patients with a glucose level≤110 mg/dL, the adjusted odds of dying were greater for patients with a glucose level >110–140 (odds ratio 1.19 [95% CI 1.00–1.42]), >140–170 (1.44 [1.17–1.77]), >170–240 (1.54 [1.26–1.90]), and >240 mg/dL (1.60 [1.26–2.03]), with no difference in the odds of hospital readmission.
CONCLUSIONS In patients with acute PE, elevated admission glucose is common and independently associated withshort-term mortality.
Elevated serum glucose level at admission during acute illness is common and associated with poor outcomes in acute cardiopulmonary diseases, such as acute myocardial infarction (1), heart failure (2), pneumonia (3), and stroke (4). During the past decade, the association between stress-induced elevated serum glucose level and the outcome of acutely ill patients hasreceived considerable attention because of the potential benefits and risks of tight glycemic control (5).
Acute pulmonary embolism (PE) is a major health problem. In 2005, 140,000 patients were discharged with a primary diagnosis of PE from U.S. hospitals (6), with an average mortality rate of 9% (7). Evidence suggests that acute and chronic hyperglycemia is associated with elevated coagulation factorsand impaired fibrinolysis (8) and an increased risk of developing venous thromboembolism (8–10). Whether admission hyperglycemia has a negative impact on prognosis in patients with acute PE is unknown. Given the potential treatment implications of such a finding, our goal was to examine whether an independent association exists between elevated admission glucose levels and 30-day mortality usinga large, statewide database of unselected patients with acute PE. A secondary objective of our study was to examine the association between elevated serum glucose levels and hospital readmission.
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RESEARCH DESIGN AND METHODS
Patient identification and eligibility
We identified all patients with PE discharged...