title: Elevated admission glucose and mortality in patients with acute pulmonary embolism.
abstract: OBJECTIVE
  Although associated with adverse outcomes in other cardiopulmonary conditions, the prognostic value of elevated glucose in patients with acute pulmonary embolism (PE) is unknown. We sought to examine the association between glucose levels and mortality and hospital readmission rates for patients with PE.
  
  
  METHODS
  We evaluated 13,621 patient discharges with a primary diagnosis of PE from 185 acute care hospitals in Pennsylvania (from January 2000 to November 2002). Admission glucose levels were analyzed as a categorical variable (≤110, >110-140, >140-170, >170-240, and >240 mg/dL). The outcomes were 30-day all-cause mortality and hospital readmission. We used random-intercept logistic regression to assess the independent association between admission glucose levels and mortality and hospital readmission, adjusting for patient (age, sex, race, insurance, comorbid conditions, severity of illness, laboratory parameters, and thrombolysis) and hospital (region, size, and teaching status) factors.
  
  
  RESULTS
  Elevated glucose (>110 mg/dL) was present in 8,666 (63.6%) patients. Patients with a glucose level ≤110, >110-140, >140-170, >170-240, and >240 mg/dL had a 30-day mortality of 5.6, 8.4, 12.0, 15.6, and 18.3%, respectively (P < 0.001). Compared with patients with a glucose level ≤110 mg/dL, the adjusted odds of dying were greater for patients with a glucose level >110-140 (odds ratio 1.19 [95% CI 1.00-1.42]), >140-170 (1.44 [1.17-1.77]), >170-240 (1.54 [1.26-1.90]), and >240 mg/dL (1.60 [1.26-2.03]), with no difference in the odds of hospital readmission.
  
  
  CONCLUSIONS
  In patients with acute PE, elevated admission glucose is common and independently associated with short-term mortality.
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland. nathalie.scherz@insel.ch
authors.forename: Nathalie
authors.initials: N
authors.lastname: Scherz
authors.forename: José
authors.initials: J
authors.lastname: Labarère
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.forename: Marie
authors.initials: M
authors.lastname: Méan
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D010414:Pennsylvania / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000401:mortality*
chemical_list: D001786:Blood Glucose
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