Emergency Department, University Hospital of Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany.
J Emerg Med. 2021 Oct;61(4):355-364. doi: 10.1016/j.jemermed.2021.04.011. Epub 2021 Jun 17.
Abnormal admission blood glucose was reported as a useful predictor of outcome in critically ill patients.
To identify patients at higher risk, this study aimed to evaluate the relationship between admission blood glucose levels and patient mortality during the management of nontraumatic critically ill patients in the emergency department (ED).
In this prospective, single-center observational study in a German university ED, all adult patients admitted to the resuscitation room of the ED were included between September 1, 2014 and August 31, 2015. Directly after resuscitation room admission, blood samples for admission blood glucose were taken, and adult patients were divided into groups according to predefined cut-offs between the admission blood glucose. Study endpoint was in-hospital mortality.
During the study period, 532 patients were admitted to the resuscitation room. The data of 523 patients (98.3%) were available for analysis. The overall in-hospital mortality was 34.2%. In comparison with an in-hospital mortality of 25.2% at an admission blood glucose of 101-136 mg/dL (n = 107), admission blood glucose of ≤ 100 mg/dL (n = 25, odds ratio [OR] 6.30, 95% confidence interval [CI] 2.44-16.23, p < 0.001), 272-361 mg/dL (n = 63, OR 2.53, 95% CI 1.31-4.90, p = 0.007), and ≥ 362 mg/dL (n = 44, OR 2.96, 95% CI 1.42-6.18, p = 0.004) were associated with a higher mortality.
Abnormal admission blood glucose is associated with a high in-hospital mortality. Admission blood glucose is an inexpensive and rapidly available laboratory parameter that may predict mortality and help to identify critically ill patients at risk in a general nontraumatic critically ill ED patient cohort. The breakpoint for in-hospital mortality may be an admission blood glucose ≤ 100 and ≥ 272 mg/dL.
入院时血糖异常被报道为危重症患者预后的有用预测指标。
为了确定更高危的患者，本研究旨在评估在急诊科（ED）非创伤性危重症患者管理期间，入院血糖水平与患者死亡率之间的关系。
这是一项在德国大学 ED 进行的前瞻性、单中心观察性研究，纳入 2014 年 9 月 1 日至 2015 年 8 月 31 日期间入住 ED 复苏室的所有成年患者。在进入复苏室后立即采集入院时血糖的血样，并根据预先设定的入院血糖切点将成年患者分为不同的组。研究终点为院内死亡率。
在研究期间，有 532 名患者入住复苏室。有 523 名患者（98.3%）的数据可用于分析。总体院内死亡率为 34.2%。与入院血糖为 101-136mg/dL（n=107）时的院内死亡率 25.2%相比，入院血糖≤100mg/dL（n=25，优势比[OR]6.30，95%置信区间[CI]2.44-16.23，p<0.001）、272-361mg/dL（n=63，OR 2.53，95%CI 1.31-4.90，p=0.007）和≥362mg/dL（n=44，OR 2.96，95%CI 1.42-6.18，p=0.004）的患者死亡率更高。
异常入院血糖与高院内死亡率相关。入院血糖是一种廉价且可快速获得的实验室参数，可能预测死亡率，并有助于在一般非创伤性危重症 ED 患者队列中识别有风险的危重症患者。院内死亡率的临界点可能是入院血糖≤100 和≥272mg/dL。
