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The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study
Author(s) -
Kutz A.,
Struja T.,
Hausfater P.,
Amin D.,
Amin A.,
Haubitz S.,
Bernard M.,
Huber A.,
Mueller B.,
Schuetz P.
Publication year - 2017
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13325
Subject(s) - medicine , triage , observational study , emergency medicine , prospective cohort study , intensive care medicine , outcome (game theory) , adverse effect , medical emergency , mathematics , mathematical economics
Aims The clinical relevance of hyperglycaemia in an emergency department population remains incompletely understood. We investigated the association between admission blood glucose levels and adverse clinical outcomes in a large emergency department cohort. Methods We prospectively enrolled 7132 adult medical patients seeking emergency department care in three tertiary care hospitals in Switzerland, France and the USA . We used adjusted multivariable logistic regression models to examine the association between admission blood glucose levels and 30‐day mortality, as well as adverse clinical course stratified by pre‐existing diabetes and principal medical diagnoses. Results In 6044 people without diabetes (84.7%), severe hyperglycaemia, defined as a glucose level of > 11.1 mmol/l (200 mg/dl), was associated with a doubling in the risk of 30‐day mortality [adjusted odds ratio ( OR ) 1.9; 95% confidence interval (95% CI ), 1.1 to 3.3; P = 0.018] and a three‐fold increase in the risk of intensive care unit admission (adjusted OR 3.0; 95% CI , 1.9 to 4.9; P < 0.001). These associations were similar among different diagnoses. In the population with diabetes ( n = 1088), no association with 30‐day mortality was found (adjusted OR 1.0; 95% CI , 0.6 to 1.8; P for interaction = 0.001), whereas the association with intensive care unit admission was weaker (adjusted OR 2.4; 95% CI , 1.5 to 4.1; P for interaction = 0.011). Overall 30‐day mortality was higher in those with diabetes than in those without (6.1 vs. 4.4%, P = 0.015). Conclusions In this large medical emergency department patient cohort, admission hyperglycaemia was strongly associated with adverse clinical course in people without diabetes. (Clinical Trial Registry No: NCT01768494)