The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study

• Published in: Diabetic medicine Vol. 34; no. 7; pp. 973 - 982
• Main Authors: Kutz, A., Struja, T., Hausfater, P., Amin, D., Amin, A., Haubitz, S., Bernard, M., Huber, A., Mueller, B., Schuetz, P.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-07-2017; Wiley
• Subjects: Aged; Blood Glucose - analysis; Clinical outcomes; Cohort Studies; Combined Modality Therapy; Diabetes; Diabetes mellitus; Emergency Service, Hospital; Emergency services; Female; Follow-Up Studies; France - epidemiology; Glucose; Hospital Mortality; Humans; Hyperglycemia; Hyperglycemia - blood; Hyperglycemia - complications; Hyperglycemia - physiopathology; Hyperglycemia - therapy; Intensive care; Life Sciences; Male; Middle Aged; Mortality; Patient Admission; Prospective Studies; Regression analysis; Risk Factors; Severity of Illness Index; Switzerland - epidemiology; Tertiary Care Centers; United States - epidemiology
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13325

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)
What's new?
We combined admission glucose levels and prospectively collected clinical data in a large multinational medical emergency cohort of over 7000 people with and without diabetes to determine the association between admission hyperglycaemia and adverse clinical outcome.
In an emergency department population with different medical diseases, pre‐existing diabetes is a significant effect modifier for the relationship between admission hyperglycaemia and risk of adverse outcome, including intensive care unit admission, and in‐hospital as well as 30‐day mortality.
Unselected medical emergency department patients with diabetes may tolerate admission hyperglycaemia better than those without diabetes.