Document Detail


Hyperglycaemia as a predictor of outcome during non-invasive ventilation in decompensated COPD.
MedLine Citation:
PMID:  19454410     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: Hyperglycaemia predicts a poor outcome in Intensive Care Unit (ICU) patients. Whether this is true for respiratory failure necessitating non-invasive ventilation (NIV) is not known.
OBJECTIVES: To determine whether hyperglycaemia within 24 h of admission independently predicts outcome of NIV during acute decompensated ventilatory failure complicating chronic obstructive pulmonary disease (COPD) exacerbations.
METHODS: Patients with COPD presenting with acute hypercapnic respiratory failure at University Hospital Aintree between June 2006 and September 2007 and receiving NIV within 24 h of admission were studied prospectively. Random blood glucose levels were measured before NIV administration.
RESULTS: 88 patients (mean baseline pH 7.25, PaCO(2) 10.20 kPa, and PaO(2) 8.19 kPa) met the inclusion criteria, with NIV normalising arterial pH off therapy in 79 (90%). After multivariate logistic regression, the following predicted outcome: baseline respiratory rate (OR 0.91; 95% CI 0.84 to 0.99), random glucose > or = 7 mmol/l (OR 0.07; 95% CI 0.007 to 0.63) and admission APACHE II (Acute Physiology and Chronic Health Evaluation II) score (OR 0.75; 95% CI 0.62 to 0.90). The combination of baseline respiratory rate (RR) <30 breaths/min and random glucose <7 mmol/l increased prediction of NIV success to 97%, whilst use of all three factors was 100% predictive.
CONCLUSIONS: In acute decompensated ventilatory failure complicating COPD, hyperglycaemia upon presentation was associated with a poor outcome. Baseline RR and hyperglycaemia are as good at predicting clinical outcomes as the APACHE II score. Combining these variables increases predictive accuracy, providing a simple method of early risk stratification.
Authors:
B Chakrabarti; R M Angus; S Agarwal; S Lane; P M A Calverley
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-05-18
Journal Detail:
Title:  Thorax     Volume:  64     ISSN:  1468-3296     ISO Abbreviation:  Thorax     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-29     Completed Date:  2009-10-29     Revised Date:  2011-06-07    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  857-62     Citation Subset:  IM    
Affiliation:
Clinical Sciences Centre, University Hospital Aintree, University of Liverpool, Liverpool L9 7AL, UK. biz@doctors.org.uk
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Blood Gas Analysis
Blood Glucose / metabolism*
Female
Humans
Hydrogen-Ion Concentration
Hypercapnia / etiology
Hyperglycemia / etiology*
Intensive Care
Male
Positive-Pressure Respiration*
Prospective Studies
Pulmonary Disease, Chronic Obstructive / blood,  therapy*
Respiratory Insufficiency / etiology
Treatment Outcome
Chemical
Reg. No./Substance:
0/Blood Glucose
Comments/Corrections
Comment In:
Thorax. 2011 May;66(5):449-50; author reply 450   [PMID:  20530118 ]
Thorax. 2009 Oct;64(10):830-2   [PMID:  19786710 ]

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