Hyperglycemia: Are we still talking about it
Paper by B Chakrabarti looked at the hyperglycemia as a predictor of outcome during non invasive ventilation in decompensated COPD.
Method: COPD patients presenting with acute hypercapnic respiratory failure at University Hospital Aintree between June 2006 and September 2007 and receiving NIV within 24 hours of admission were prospectively studied. Random blood glucose levels were measured before NIV administration. 88 patients met inclusion criteria
Results: After multi-variate logistic regression, the following predicted outcome:
- Admission APACHE II score (OR 0.75; 95% CI 0.62-0.90).
- The combination of baseline RR less than 30 breaths per minute and random glucose less than 7mmol/l (127.27 mg/dl) increased prediction of NIV success to 97% whilst use of all 3 factors was 100% predictive.
- In acute decompensated ventilatory failure complicating COPD, hyperglycaemia upon presentation was associated with a poor outcome.
- Baseline respiratory rate and hyperglycaemia are as good at predicting clinical outcomes as the APACHE 2 score.
- Combining these variables increases predictive accuracy providing a simple method of early risk stratification.
Reference: click to get abstract
Chakrabarti B, Angus RM, Agarwal S, Lane S, Calverley P. Hyperglycaemia as a predictor of outcome during Non Invasive Ventilation in decompensated COPD. Thorax 18 May 2009. Published online first.
