Diabetes mellitus with poor glycemic control is a risk factor for pneumonia in COPD. - 07/08/24

Doi : 10.1016/j.resmer.2024.101135

Rafael Golpe ^1,^⁎ , Juan-Marco Figueira-Gonçalves ^2,³, Laura Arias-Zas ¹, David Dacal-Rivas ¹, Nagore Blanco-Cid ¹, Olalla Castro-Añón ¹
¹ Servicio de Neumología. Hospital Universitario Lucus Augusti, Lugo, Spain
² Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
³ University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain

^⁎Correspondence: Rafael Golpe. Servicio de Neumología. Unidad administrativa 4-A. Hospital Universitario Lucus Augusti. Calle Dr Ulises Romero n°1, 27003, Lugo (Spain). Telf: (00 34) 982 29 68 59.Servicio de NeumologíaUnidad administrativa 4-AHospital Universitario Lucus AugustiCalle Dr Ulises Romero n°1Lugo27003Spain

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Abstract

Background

: Pneumonias are events of great prognostic significance in COPD, so it is important to identify predictive factors.

Objective

: To determine whether poor glycemic control is related to an increased risk of pneumonia in COPD.

Method

: A historical cohort study conducted in a COPD clinic. The first severe exacerbation after the first visit was analyzed. Exacerbations that presented with pulmonary infiltrates were identified. A Cox proportional hazards analysis was performed including the values of glycosylated hemoglobin (Hb1Ac) in patients with diabetes mellitus (DM) and variables that could plausibly be related to the risk of pneumonia. The best Hb1Ac value to predict pneumonia was assessed using receiver-operating characteristics analysis.

Results

: There were 1124 cases included in the study. A total of 411 patients were admitted to the hospital at least once and 87 were diagnosed with pneumonia. Variables associated with the risk of pneumonia were previous admissions due to COPD and Hb1Ac values (HR: 2.33, 95 % CI: 1.06 – 5.08, p= 0.03). A higher body mass index (BMI) was associated with a lower risk of pneumonia. The optimal cutoff point for Hb1Ac to predict pneumonia risk was 7.8%. The patients were classified into 3 groups: (1) no DM, (2) controlled DM (Hb1AC < 7.8%), (3) uncontrolled DM (Hb1AC ≥ 7.8%). The risk of pneumonia for group 2 was not different from group 1, while the risk for group 3 was significantly higher than for groups 1 and 2 (HR: 4.52, 95% CI: 1.57 – 13.02).

Conclusions

: Poor control of DM is a predictor of the risk of pneumonia in COPD. The cutoff point of 7.8% for this variable seems to be the most useful to identify patients at risk.

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Key words : Pulmonary disease, chronic obstructive, pneumonia, diabetes mellitus, glycated hemoglobin, exacerbation

Abbreviations : BMI, COPD, DM, Hb1AC, ROC

Plan

Compliance with ethical standards

Results

Discussion

Authors contribution: R.G.: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, had full access to all of the data in the study and takes responsability for the integrity of the data and the accuracy of the data analysis. J.M.F-G.: study concept and design, analysis and interpretation of data, drafting of the manuscript. L.A-Z., D.D-R., N.B-C., O.C-A.: acquisition of data, administrative support, critical revision of the manuscript for important intellectual content. All the authors approved the final version to be published.

No funding was received to assist with the preparation of this manuscript or for conducting this study. The authors have no conflicts of interest to declare that are relevant to the content of this article.