Patients With Pneumonia and Hypoglycemia Have a Very High Risk for Mortality

Terry Hartnett

April 13, 2010

April 13, 2010 (Washington, DC) — Patients who have low blood sugar are at increased risk for mortality if they contract pneumonia. The comorbidity quadruples their risk for death, and hospitalists can play a key role in the management of these patients, investigators reported here at Hospital Medicine 2010: Society of Hospital Medicine (SHM) Annual Meeting.

Patients with hypoglycemia and pneumonia should be closely monitored, regardless of the level of risk reflected on pneumonia-specific risk systems, and even if, according to these risk assessment systems, they would normally be discharged, said Sean Garcia, MD, a hospitalist at the University of Texas Health Sciences Center in San Antonio.

The 30-day mortality risk ranges from 9% to 27%, according to the traditional scoring measures of CURB-65 and the Pneumonia Severity Index, he reported.

Dr. Garcia told Medscape Internal Medicine that published studies have shown a link between hypoglycemia and risk for mortality in elderly patients and in patients with sepsis or Escherichia coli in the blood, and in children with pneumonia.

"I wanted to assess the possible connection between low blood sugar and adult pneumonia," he told meeting attendees.

As their definition of hypoglycemia, Dr. Garcia and his colleagues used blood glucose levels lower than 70 mg/dL. They reviewed the medical records of 787 patients diagnosed with community-acquired pneumonia. Of those, 22 (2.8%) had hypoglycemia on admission to the hospital. The unadjusted mortality for hypoglycemic patients was 27.3%, and for normoglycemic patients was 8.6%.

On hospital admission, patients with pneumonia were assessed for risk for mortality. More than half (55%) had a low risk for mortality, 33% had a moderate risk, and 12% had a high risk.

Dr. Garcia said that patients at otherwise low risk for mortality with pneumonia are generally treated for the infection, and little attention is paid to the risk posed by hypoglycemia.

"Basic science research suggests that the link between the 2 may have something to do with the body's response to stress," said Dr. Garcia. "We don't know exactly why, but this study makes it pretty clear that low blood sugar is a significant marker of mortality for patients with pneumonia," he said.

A comprehensive care plan, including round the clock monitoring by a hospitalist, is needed for patients who have this high mortality risk, said Danielle Scheurer, MD, physician spokesperson for SHM and a hospitalist at Brigham and Women's Hospital in Boston, Massachusetts.

"Our role is to identify the intensity of service that is required for each patient, and the increased mortality risk from hypoglycemia is a good example of the need for this specialized attention," said Dr. Scheurer. "Cases like this are always complicated and require the physician to be able to make changes in the care plan in real time," she said.

Dr. Garcia recommended that patients with low blood sugar and pneumonia be monitored continually for blood sugar readings and any progression of the disease, perhaps in a step-down hospital unit or, at minimum, a closely monitored setting.

"The hallmark of multidisciplinary care is the ability to have repeated decision-making," Dr. Scheurer added.

Above all, said Drs. Garcia and Scheurer, patients who have this high a risk for mortality should not be discharged from the hospital.

The study did not receive commercial support. Dr. Garcia and Dr. Scheurer have disclosed no relevant financial relationships.

Hospital Medicine 2010: Society of Hospital Medicine (SHM) Annual Meeting. Abstract 55. Presented April 9, 2010.

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