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17-11-2011 | Cardiology | Article

Raised blood sugar linked to poor prognosis in PE

Abstract

Free abstract

MedWire News: More than half of patients with pulmonary embolism (PE) have an elevated blood glucose level at the time of presentation, which puts them at increased risk for short-term mortality, study findings indicate.

"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, heart failure, pneumonia, and stroke," explain Nathalie Scherz (Bern University Hospital, Switzerland) and colleagues.

"Whether admission hyperglycemia has a negative impact on prognosis in patients with acute PE is unknown," they add.

To investigate, the researchers reviewed the medical records of 13,621 patients discharged with a diagnosis of PE from 185 hospitals in Pennsylvania, USA, during 2000-2002.

On admission, 8666 (63.6%) patients had an elevated serum glucose level (>110 mg/dL). Of these, 1685 (19.4%) were known to have diabetes.

A total of 1301 (9.6%) patients died within 30 days of presentation. The risk for death increased with increasing admission glucose level, Scherz and co-authors report in the journal Diabetes Care.

Specifically, patients with a glucose level below 110, 111-140, 141-170, 171-240, and above 240 mg/dL had 30-day mortality rates of 5.6%, 8.4%, 12.0%, 15.6%, and 18.3%, respectively.

After adjustment for patient and hospital characteristics, patients with glucose levels of 111-140, 141-170, 171-240, and above 240 mg/dL had 1.19-, 1.44-, 1.54-, and 1.60-fold increased risks for dying within 30 days, compared with those with a serum glucose level at or below 110 mg/dL.

No such associations were observed for hospital readmission rates, however.

Scherz et al suggest that the association they observed may occur because elevated serum glucose levels have a procoagulant effect and decrease fibrinolysis, or because hyperglycemia is often accompanied by hyperinsulinemia, which may further inhibit fibrinolysis and increase the prothrombotic effect of hyperglycemia.

It is also possible that "hyperglycemia is not a causal factor for adverse clinical outcomes but merely a marker of increased stress and severity of illness," they say.

The researchers conclude: "Clinically, patients with PE who have hyperglycemia at presentation carry a higher risk of short-term mortality and may therefore potentially benefit from more intensive surveillance in the hospital and after discharge."

They add that further research is warranted "to determine whether glucose-lowering treatment with insulin is associated with improved outcomes for patients with PE."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Laura Dean

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