In-hospital hyperglycemia but not diabetes mellitus alone is associated with increased in-hospital mortality in community-acquired pneumonia (CAP): a systematic review and meta-analysis of observational studies prior to COVID-19

Barmanray, RD; Cheuk, N; Fourlanos, S; Greenberg, PB; Colman, PG; Worth, LJ

Author(s): Barmanray, RD; Cheuk, N; Fourlanos, S; Greenberg, PB; Colman, PG; Worth, LJ;
Details: Publication Year 2022-07,Volume 10,Issue #4,Page e002880
Journal Title: BMJ Open Diabetes Research & Care
Publication Type: Review
Abstract: The objective of this review was to quantify the association between diabetes, hyperglycemia, and outcomes in patients hospitalized for community-acquired pneumonia (CAP) prior to the COVID-19 pandemic by conducting a systematic review and meta-analysis. Two investigators independently screened records identified in the PubMed (MEDLINE), EMBASE, CINAHL, and Web of Science databases. Cohort and case-control studies quantitatively evaluating associations between diabetes and in-hospital hyperglycemia with outcomes in adults admitted to hospital with CAP were included. Quality was assessed using the Newcastle-Ottawa Quality Assessment Scale, effect size using random-effects models, and heterogeneity using I(2) statistics. Thirty-eight studies met the inclusion criteria. Hyperglycemia was associated with in-hospital mortality (adjusted OR 1.28, 95% CI 1.09 to 1.50) and intensive care unit (ICU) admission (crude OR 1.82, 95% CI 1.17 to 2.84). There was no association between diabetes status and in-hospital mortality (adjusted OR 1.04, 95% CI 0.72 to 1.51), 30-day mortality (adjusted OR 1.13, 95% CI 0.77 to 1.67), or ICU admission (crude OR 1.91, 95% CI 0.74 to 4.95). Diabetes was associated with increased mortality in all studies reporting >90-day postdischarge mortality and with longer length of stay only for studies reporting crude (OR 1.50, 95% CI 1.11 to 2.01) results. In adults hospitalized with CAP, in-hospital hyperglycemia but not diabetes alone is associated with increased in-hospital mortality and ICU admission. Diabetes status is associated with increased >90-day postdischarge mortality. Implications for management are that in-hospital hyperglycemia carries a greater risk for in-hospital morbidity and mortality than diabetes alone in patients admitted with non-COVID-19 CAP. Evaluation of strategies enabling timely and effective management of in-hospital hyperglycemia in CAP is warranted.
Keywords: Adult; Aftercare; *covid-19; *Community-Acquired Infections/complications; *Diabetes Mellitus/epidemiology; Hospital Mortality; Hospitals; Humans; *Hyperglycemia/complications; Pandemics; Patient Discharge; *Pneumonia/complications; diabetes mellitus, type 2; hospitalization; hyperglycemia; infections
Department(s): Infectious Diseases
PubMed ID: 35790320
Publisher's Version: https://doi.org/10.1136/bmjdrc-2022-002880
Open Access at Publisher's Site: https://doi.org/10.1136/bmjdrc-2022-002880
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-09-26 05:45:25

Last Modified: 2024-09-26 05:48:04