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Admission glucose level was associated with increased short-term mortality and length-of-stay irrespective of diagnosis, treating medical specialty or concomitant laboratory values

Björk, Magnus ; Melin, Eva O. LU ; Frisk, Thomas and Thunander, Maria LU (2020) In European Journal of Internal Medicine
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.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Admission glucose, Diagnoses, Hypoglycemia, Laboratory values, Length-of-stay, Mortality
in
European Journal of Internal Medicine
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
2020-05-26 05:39:12
@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 (&gt;4.0–≤7.0), modest (&gt;7.0–≤11.1) and severe hyperglycemia (&gt;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 &lt; 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},
  language     = {eng},
  month        = {01},
  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},
  year         = {2020},
}