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Hyperglycemia at hospital admission increases adverse clinical outcome risk
Adults without diabetes may have an increased risk for 30-day mortality, ICU admission and longer length of hospital stay if they have hyperglycemia at admission to the ED, study data from Switzerland show.
Alexander Kutz, MD, of the university department of medicine at Kantonsspital Aarau in Switzerland, and colleagues evaluated data from the TRIAGE study on 7,132 adults (53.3% men; median age, 62 years) who sought ED care from March 2013 to October 2014 to determine the association between admission blood glucose levels and adverse clinical outcomes. Thirty-day complete follow-up information was available for all participants.
Overall, 15.3% of participants had diabetes. Compared with participants who had hyperglycemia or euglycemia, participants with diabetes had a higher 30-day mortality rate (P < .001), increased ICU admission rate (P < .001) and longer length of stay (P < .001).
Among participants without diabetes, those with moderate (6-11.1 mmol/L) and severe (> 11.1 mmol/L) hyperglycemia had higher rates of 30-day mortality compared with participants with euglycemia. Participants without diabetes but with glucose levels greater than 11.1 mmol/L had double the risk for 30-day mortality (OR = 1.9; 95% CI, 1.1-3.3) and triple the risk for ICU admission (OR = 3; 95% CI, 1.9-4.9). Glucose levels greater than 11.1 mmol/L were associated with strong trends for in-hospital mortality (OR = 1.9; 95% CI, 1-3.6) and longer length of stay (OR = 1.5; 95% CI, 1-2.3).
“Our findings suggest that the diabetes status is an important effect modifier for the association of hyperglycemia and adverse outcome,” the researchers wrote. “Although high initial glucose levels were associated with adverse outcomes in the population without diabetes, no similar effects were found in people with diabetes. Although underlying pathophysiological mechanisms might be multifactorial, further investigation is warranted, first to clarify the underlying pathophysiology, and second to define target glucose levels in [ED] patients, implementing an insulin protocol that performs in both patients without and with diabetes.” – by Amber Cox
Disclosure: Kutz reports financial ties with bioMérieux and ThermoFisher Scientific Biomarkers. Please see the full study for a list of all other authors’ relevant financial disclosures.