Corticosteroid administration and glycemic outcomes during treatment of acute exacerbation of chronic obstructive pulmonary disease

Abstract

Background

While international guidelines recommend low doses of systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) clinical practice patterns show significant heterogeneity. Increasing doses of corticosteroids have inconsistently been associated with a greater risk of hyperglycemia.

Methods

Patients admitted to inpatient services for AECOPD were retrospectively enrolled. Hospitalization corticosteroid doses, daily blood glucose levels, and other markers of corticosteroid excess were collected. Correlative and regression analyses were conducted to assess the relationship between corticosteroid dose and average hospitalization blood glucose.

Results

Daily corticosteroid dose significantly predicted a higher blood glucose (rs=0.179, p=0.0095; p<0.0028 respectively) and cumulative corticosteroid dose predicted a longer hospital length of stay in bivariate and multivariate analyses (rs=0.679, p<0.0001; p<0.0001 respectively). Patients that experienced hypernatremia, hypokalemia, acute hyperglycemia, and acute hypertension received larger corticosteroid doses than patients that did not experience these complicating events.

Conclusions

We identified that increasing amounts of corticosteroids administered to inpatients experiencing AECOPD experienced higher average hospitalization blood glucose values, protracted hospitalizations, and other untoward effects.