Is blood glucose on admission a predictor of mortality in adult acute pneumonia?

BACKGROUND: Even if hyperglycaemia is often identified as an independent risk factor for developing respiratory tract infection, only few studies have investigated this relationship. The aim of this study is to investigate if plasma glucose on admission is related with in-hospital mortality among patients with pneumonia and to identify the glycaemic range with significant reductions of mortality risks in non-intensive care patients. METHODS: Data come from administrative records of 1018 non-intensive care patients hospitalised with diagnosis of pneumonia. For every patient, administrative records were linked with the plasma glucose. A multivariate logistic regression model was performed in order to evaluate the associations between in-hospital mortality and a set of demographic and clinical variables. Plasma glucose was added to the model as restricted cubic spline; risk estimates for hypoglycaemic and hyperglycaemic patients have been derived on the basis of this nonlinear model and presented with two values of odds ratio (OR). RESULTS: The minimal risk of in-hospital mortality was found at plasma glucose levels of mean 86 mg/dL [95% confidence interval (CI) 61-102]. The adjusted OR of deaths for plasma glucose on admission for hypoglycaemic patients (below 86 mg/dL) is 0.78 (95% CI 0.62-0.98) for each 10 mg/dL of decrease, whereas for hyperglycaemic patients (above 86 mg/dL), the OR is 1.33 (95% CI 1.07-1.66) for each 10 mg/dL of increase in plasma glucose. CONCLUSIONS: Our observations suggest that in non-intensive care patients, hypoglycaemia, as hyperglycaemia, is associated with in-hospital mortality.

Therapeutic monitoring of tacrolimus: aberrant results by an immunoassay with automated pretreatment.

BACKGROUND AND AIMS: The therapeutic monitoring of Tacrolimus (FK506) is necessary since low doses may cause graft rejection while overdosage is linked to nephrotoxicity, neurotoxicity, and many other adverse effects. Occasional notices of elevated values recorded in patients under maintenance regimen have prompted us to record all results exceeding the therapeutic range (>15 ng/mL) with no clinical signs or explanation and to compare the routine method (Siemens-Dade Dimension XPand) with other assays. METHODS: Eighty-four whole blood samples from 8 patients have been assayed by Dimension and by one or more of three other commercial assays (CMIA and MEIA, Abbott; EMIT, Siemens-Dade). As a reference, an automated LC-MS/MS method has been performed. RESULTS: In all cases the raised Tacrolimus values were observed only by ACMIA, while the correlation (r2) of the other assays with LC-MS/MS was excellent for CMIA (0.97) and good for MEIA (0.88) and EMIT (0.83). The aberrant results were often recorded over a span of several weeks or months and could not be ascribed to a common cause. DISCUSSION: Abnormally high Tacrolimus results by the ACMIA method have been observed in 1% of the patients currently followed up in our Center. Since these results may lead to erroneous adjustments of the drug dosage, we suggest checking any elevated or clinically unexplained Tacrolimus result by the ACMIA assay with other method(s) requiring an external pretreatment.

Normal glucose values are associated with a lower risk of mortality in hospitalized patients.

OBJECTIVE: Hyperglycemia is a common condition in hospitalized patients. The aim of this study was to investigate the relationships between glycemia upon admission and mortality in a heterogeneous group of adult patients. RESEARCH DESIGN AND METHODS: The 3-year records released from a general hospital were associated with a plasma glucose dataset of its general laboratory. A matched case-control study was implemented (3,338 case-control subject pairs). All-patient refined diagnosis-related groups and the relative risk of death were the matching criteria. A multivariate conditional logistic regression model was used to evaluate the associations between death and glycemia. RESULTS: Higher in-hospital mortality was associated with hyperglycemia or hypoglycemia, whereas lower risk was observed for values between 78 and 101 mg/dl. CONCLUSIONS: Our data confirm the relation between glycemia upon admission and mortality and suggest that slightly increased or decreased plasma glucose can be linked with increased mortality risk.

Associations of dietary and serum copper with inflammation, oxidative stress, and metabolic variables in adults.

There are conflicting data on the associations between copper and glycemia, plasma lipids, and atherosclerotic diseases. Copper has both pro-oxidant and antioxidant effects. We performed a cross-sectional analysis to investigate the associations between dietary copper intake and metabolic variables and serum high-sensitivity C-reactive protein (hs-CRP) in asymptomatic subjects from a population-based cohort (n = 1197) and between serum copper concentration and markers of oxidative stress, including plasma nitrotyrosine (NT) and total antioxidant status (TAS), hs-CRP, and metabolic variables in a subgroup of men from this cohort (n = 231). In all subjects, diastolic blood pressure and circulating glucose, uric acid, and total and LDL-cholesterol concentrations significantly decreased, whereas the hs-CRP concentration increased, from the lowest to the highest tertile of copper intake. In the male subgroup, glucose and total and LDL-cholesterol and TAS decreased, whereas hs-CRP and NT concentrations increased from the lowest to the highest tertile of serum copper concentration. In multiple regression models, dietary copper intake was inversely associated with diastolic blood pressure (P = 0.002), fasting glucose (P < 0.001), total cholesterol (P < 0.001), LDL-cholesterol (P < 0.001), and uric acid (P < 0.001) and was directly associated with the hs-CRP concentration (P < 0.001). Serum copper concentrations were inversely associated with glucose (P < 0.001), total cholesterol (P < 0.001), LDL-cholesterol (P < 0.001), and TAS (P < 0.001) and were directly associated with hs-CRP (P < 0.001) and NT concentrations (P < 0.001). Marginal copper deficiency is associated with an unfavorable metabolic pattern, but copper supplementation might not be recommended in view of its association with inflammation and markers of oxidative stress.