Glycated hemoglobin (HbA1c) and acute exacerbation in chronic obstructive pulmonary disease: a potent biomarker of severity and prognosis. Preliminary data.

Introduction: COPD and impaired glycemic control are characterized by systemic inflammation. Etiologic correlation between them is under investigation. Objective: The aim of this study is to examine the prognostic value of HbA1c levels in an acute exacerbation of COPD (AECOPD) as well as in COPD disease9s morbidity and mortality during the following year. Methods: Levels of HbA1c were recorded in patients admitted to the hospital for an AECOPD. Values above 6.5 % were considered high. All subjects were followed up for one year, their vital status and new AECOPD events were recorded. The study outcomes included duration of hospital stay, need for mechanical ventilation, time to next AECOPD and death. Results: Thirty-seven patients optimally treated were included. HbA1c was high in 7 (18.9%) patients. There was no difference in the duration of hospital stay between patients with low an high HbA1c levels (p=0.149). Though 57% of patients with high levels of HbA1c required mechanical ventilation vs 13% of patients with low HbA1c levels (p=0.012). In the follow up year no significant difference was observed in the time of the next AECOPD, the time of the next hospitalization for AECOPD and one-year mortality between the two study groups (p=0.258, p=0.929, p=0.076 respectively, Log Rank test). Conclusion: Preliminary data indicate that HbA1c levels >6.5% could be used as a prognostic biomarker of an exacerbation9s severity and could possibly be extended to to predicting one year mortality. Increased HbA1c levels are likely to reflect an increased inflammatory state which amplifies the risk of COPD disease9s adverse effects.