Elangovan Akilan, Cattamanchi Srihari, Farook Abdul Razack, Trichur Ramakrishnan Venkatakrishnan
Department of Emergency Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
J Emerg Trauma Shock. 2018 Apr-Jun;11(2):104-110. doi: 10.4103/JETS.JETS_2_17.
Predicting hyperglycemic crisis death (PHD) score is a simple, rapid tool with six independent mortality predictors to calculate 30-day mortality and appropriately dispose patients to Intensive Care Unit (ICU) or ward.
This study aimed at validating the efficiency of PHD score as a decision rule for prognosticating 30-day mortality and classifying hyperglycemic crisis patients for appropriate disposition from the emergency department (ED).
This is a prospective, observational study done in the ED of a teaching hospital over 14 months. All patients aged >18 years and who met the criteria of hyperglycemic crisis were enrolled. Thirty-day mortality of six independent predictors was the primary end point. Using PHD, risk scores were calculated and patients were disposed as per physician's clinical judgment. Finally, the treating physician's decision and PHD score disposition were compared and the efficiency of PHD in predicting 30-day mortality was analyzed. Multiple logistic regression models were used for analysis. Receiver operating characteristic curve was drawn, and area under the curve along with sensitivity, specificity, positive predictive value, and negative predictive value was analyzed. < 0.05 was considered statistically significant.
A total of 133 patients were included. On applying PHD score, 69, 39, and 25 patients were in the low-, intermediate-, and high-risk groups, respectively, with a mortality rate of 5.8%, 20.5%, and 56%, respectively. On comparing physician disposition with PHD score, an increasing mortality was noticed in ICU, and PHD showed equal weight in risk stratification and appropriate disposition of patients.
In adult patients with hyperglycemic crisis, PHD score is validated as a straightforward, prompt tool for predicting 30-day mortality and aids in disposition. The mortality rate in the PHD score Model II was similar to the physician's clinical decision.
预测高血糖危象死亡（PHD）评分是一种简单、快速的工具，有六个独立的死亡率预测指标，用于计算30天死亡率，并将患者合理分配到重症监护病房（ICU）或普通病房。
本研究旨在验证PHD评分作为预测30天死亡率的决策规则以及对急诊科（ED）高血糖危象患者进行合理分类处置的有效性。
这是一项在一家教学医院急诊科进行的为期14个月的前瞻性观察研究。纳入所有年龄>18岁且符合高血糖危象标准的患者。六个独立预测指标的30天死亡率是主要终点。使用PHD计算风险评分，并根据医生的临床判断对患者进行处置。最后，比较治疗医生的决策和PHD评分处置情况，并分析PHD预测30天死亡率的有效性。采用多因素逻辑回归模型进行分析。绘制受试者工作特征曲线，并分析曲线下面积以及敏感性、特异性、阳性预测值和阴性预测值。P<0.05被认为具有统计学意义。
共纳入133例患者。应用PHD评分时，低、中、高风险组分别有69例、39例和25例患者，死亡率分别为5.8%、20.5%和56%。将医生的处置与PHD评分进行比较时，发现ICU患者的死亡率增加，且PHD在患者风险分层和合理处置方面显示出同等的权重。
在成年高血糖危象患者中，PHD评分被验证为一种直接、快速的预测30天死亡率并有助于处置的工具。PHD评分模型II中的死亡率与医生的临床决策相似。
