Admission glucose level was associated with increased short-term mortality and length-of-stay irrespective of diagnosis, treating medical specialty or concomitant laboratory values
(2020) In European Journal of Internal Medicine 75. p.71-78- Abstract
Background: Glucose is a routine emergency sample. General guidelines for inpatient hyperglycemia are scarce, except in myocardial infarction, stroke, and perioperative/ICU. Previous studies found admission glucose associated with increased mortality in specific conditions. Scandinavian data, and for general patients, are scarcer. We investigated admission glucose levels, 30-day mortality, and length-of-stay (LoS), in a Swedish hospital. Methods: From 8146 emergency visits data regarding age, gender, dates of admission, discharge and death, diagnoses, admission p-glucose, s-sodium, s-potassium, b-hemoglobin, b-WBC and s-CRP, was collected, and for 6283 information regarding diagnosis of diabetes the previous 5 years. Visits were grouped... (More)
Background: Glucose is a routine emergency sample. General guidelines for inpatient hyperglycemia are scarce, except in myocardial infarction, stroke, and perioperative/ICU. Previous studies found admission glucose associated with increased mortality in specific conditions. Scandinavian data, and for general patients, are scarcer. We investigated admission glucose levels, 30-day mortality, and length-of-stay (LoS), in a Swedish hospital. Methods: From 8146 emergency visits data regarding age, gender, dates of admission, discharge and death, diagnoses, admission p-glucose, s-sodium, s-potassium, b-hemoglobin, b-WBC and s-CRP, was collected, and for 6283 information regarding diagnosis of diabetes the previous 5 years. Visits were grouped in hypoglycemia (≤4.0), normoglycemia (>4.0–≤7.0), modest (>7.0–≤11.1) and severe hyperglycemia (>11.1) mmol/l. Results: Short-term mortality was 1.5% in the normoglycemic, 2.6% in the hypoglycemic, 4.0–4.5% in modest and severe hyperglycemia, p < 0.001; Cox proportional hazard ratios (HR) for groups of patients without/with diabetes were 6.8; 1; 3.4; 4.4/7.3; 3.9; 4.0; 2.1 compared to the normoglycemic without diabetes (p 0.0001–0.05); adjusted for age, and concurrent levels of sodium, potassium, Hb, WBC and CRP 1.51 (1.07–2.1, p 0.02) with modest hyperglycemia, and 1.08 (0.60–1.95, p 0.80) in severe hyperglycemia. Mean LoS was 1.2 and 1.7 days longer with modest and severe hyperglycemia. Conclusions: Short-term mortality increased substantially with admission hypo- and hyperglycemia for patients both with and without diabetes, irrespective of treating medical specialty, main discharge diagnosis, or concurrent laboratory values. Patients with diabetes (16%) were older, with higher glucose levels at admission, and with a different pattern of the association of admission glucose and mortality.
(Less)
- author
- Björk, Magnus ; Melin, Eva O. LU ; Frisk, Thomas and Thunander, Maria LU
- organization
- publishing date
- 2020-05-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Admission glucose, Diagnoses, Hypoglycemia, Laboratory values, Length-of-stay, Mortality
- in
- European Journal of Internal Medicine
- volume
- 75
- pages
- 8 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85078211313
- pmid:31982283
- ISSN
- 0953-6205
- DOI
- 10.1016/j.ejim.2020.01.010
- language
- English
- LU publication?
- yes
- id
- 9ef1f6c2-a9ab-4de6-a892-828ef463d33a
- date added to LUP
- 2020-02-06 15:59:09
- date last changed
- 2024-06-26 10:18:46
@article{9ef1f6c2-a9ab-4de6-a892-828ef463d33a,
abstract = {{<p>Background: Glucose is a routine emergency sample. General guidelines for inpatient hyperglycemia are scarce, except in myocardial infarction, stroke, and perioperative/ICU. Previous studies found admission glucose associated with increased mortality in specific conditions. Scandinavian data, and for general patients, are scarcer. We investigated admission glucose levels, 30-day mortality, and length-of-stay (LoS), in a Swedish hospital. Methods: From 8146 emergency visits data regarding age, gender, dates of admission, discharge and death, diagnoses, admission p-glucose, s-sodium, s-potassium, b-hemoglobin, b-WBC and s-CRP, was collected, and for 6283 information regarding diagnosis of diabetes the previous 5 years. Visits were grouped in hypoglycemia (≤4.0), normoglycemia (>4.0–≤7.0), modest (>7.0–≤11.1) and severe hyperglycemia (>11.1) mmol/l. Results: Short-term mortality was 1.5% in the normoglycemic, 2.6% in the hypoglycemic, 4.0–4.5% in modest and severe hyperglycemia, p < 0.001; Cox proportional hazard ratios (HR) for groups of patients without/with diabetes were 6.8; 1; 3.4; 4.4/7.3; 3.9; 4.0; 2.1 compared to the normoglycemic without diabetes (p 0.0001–0.05); adjusted for age, and concurrent levels of sodium, potassium, Hb, WBC and CRP 1.51 (1.07–2.1, p 0.02) with modest hyperglycemia, and 1.08 (0.60–1.95, p 0.80) in severe hyperglycemia. Mean LoS was 1.2 and 1.7 days longer with modest and severe hyperglycemia. Conclusions: Short-term mortality increased substantially with admission hypo- and hyperglycemia for patients both with and without diabetes, irrespective of treating medical specialty, main discharge diagnosis, or concurrent laboratory values. Patients with diabetes (16%) were older, with higher glucose levels at admission, and with a different pattern of the association of admission glucose and mortality.</p>}},
author = {{Björk, Magnus and Melin, Eva O. and Frisk, Thomas and Thunander, Maria}},
issn = {{0953-6205}},
keywords = {{Admission glucose; Diagnoses; Hypoglycemia; Laboratory values; Length-of-stay; Mortality}},
language = {{eng}},
month = {{05}},
pages = {{71--78}},
publisher = {{Elsevier}},
series = {{European Journal of Internal Medicine}},
title = {{Admission glucose level was associated with increased short-term mortality and length-of-stay irrespective of diagnosis, treating medical specialty or concomitant laboratory values}},
url = {{http://dx.doi.org/10.1016/j.ejim.2020.01.010}},
doi = {{10.1016/j.ejim.2020.01.010}},
volume = {{75}},
year = {{2020}},
}