Association of HbA1c with Outcomes in Patients of Acute Exacerbation of COPD in Tertiary Care Hospital

Manisha Dilip Rajak, Mazher Maqusood, Pradeep Nirala, Chinmay Jethi, Abhishek Kumar, Rajul Rastogi, Ajay Kumar, Chayan Chaplot, Arpit Goel, Hemax Gandhi
Author(s)
1Resident, Department of Respiratory Medicine, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India. 2Professor & HOD, Department of Respiratory Medicine, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India. 3Professor, Department of Respiratory Medicine, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India. 4Assistant Professor, Department of Respiratory Medicine, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India. 5Associate Professor, Department of Respiratory Medicine, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India. 6Professor, Department of Radiology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India. 7Professor, Department of Medicine, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India.

Abstract

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a major cause of morbidity, mortality, and hospitalization worldwide. Hyperglycemia is a common response to acute illness; however, the influence of chronic glycemic status, as reflected by glycated hemoglobin (HbA1c), on clinical outcomes in AECOPD remains uncertain. This study aimed to evaluate the association between HbA1c levels and clinical outcomes in patients admitted with AECOPD. Material and Methods: A hospital-based cross-sectional study was conducted in the Department of Respiratory Medicine over 18 months and included 205 patients aged ≥40 years admitted with AECOPD. HbA1c was measured at admission, and patients were categorized into HbA1c ≤6% and >6% groups. Clinical outcomes assessed included duration of hospital stay, mortality, need for non-invasive ventilation (NIV), invasive mechanical ventilation (IMV), and ICU outcomes. Statistical analysis was performed using the independent t-test and Chi-square test, with p<0.05 considered statistically significant. Results: The mean age of the study population was 63.74±9.46 years, and 82.0% of patients were male. Most participants were smokers (85.4%) and from rural areas (65.4%). Patients with HbA1c >6% had a significantly longer hospital stay than those with HbA1c ≤6% (8.08±2.20 vs. 7.44±2.19 days; p=0.042). A significantly higher proportion of patients with HbA1c >6% required NIV support (51.1% vs. 38.5%; p=0.036). However, HbA1c showed no significant association with mortality (p>0.05), invasive mechanical ventilation requirement (p=0.50), or ICU outcomes (p=0.55). Conclusion: Elevated HbA1c was associated with prolonged hospitalization and an increased requirement for non-invasive ventilation among patients with AECOPD, suggesting that poor long-term glycemic control adversely influences disease severity. However, HbA1c was not associated with mortality, invasive mechanical ventilation, or ICU outcomes. Routine assessment of HbA1c at hospital admission may help identify patients at greater risk of adverse in-hospital outcomes and facilitate appropriate risk stratification and management.

Keywords: Acute exacerbation of COPD; HbA1c; Non-invasive ventilation; Mortality; Hospital stay.

Outline