title: An elevated gap between admission and A1C-derived average glucose levels is associated with adverse outcomes in diabetic patients with pyogenic liver abscess.
abstract: OBJECTIVE
  To assess whether chronic glycemic control and stress-induced hyperglycemia, determined by the gap between admission glucose levels and A1C-derived average glucose (ADAG) levels adversely affects outcomes in diabetic patients with pyogenic liver abscess (PLA).
  
  
  METHODS
  Clinical, laboratory, and multi-detector computed tomography (MDCT) findings of 329 PLA patients (2004-2010) were retrospectively reviewed. HbA1C levels were used to determine long-term glycemic control status, which were then converted to estimated average glucose values. For the gap between admission glucose levels and ADAG levels, we used receiver operating characteristic (ROC) curve to determine the optimal cut-off values predicting adverse outcomes. Univariate and multivariate logistic regressions were used to identify predictors of adverse outcomes.
  
  
  RESULTS
  Diabetic PLA patients with poorer glycemic control had significantly higher Klebsiella pneumoniae (KP) infection rates, lower albumin levels, and longer hospital stays than those with suboptimal and good glycemic control. The ROC curve showed that a glycemic gap of 72 mg/dL was the optimal cut-off value for predicting adverse outcomes and showed a 22.3% relative increase in adverse outcomes compared with a glycemic gap<72 mg/dL. Multivariate analysis revealed that an elevated glycemic gap≥72 mg/dL was important predictor of adverse outcomes.
  
  
  CONCLUSIONS
  A glycemic gap≥72 mg/dL, rather than admission hyperglycemia or chronic glycemic control, was significantly correlated with adverse outcomes in diabetic PLA patients. Poorer chronic glycemic control in diabetic PLA patients is associated with high incidence of KP infection, hypoalbuminemia and longer hospital stay.
authors.affiliation: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Wen-I
authors.initials: WI
authors.lastname: Liao
authors.forename: Wayne Huey-Herng
authors.initials: WH
authors.lastname: Sheu
authors.forename: Wei-Chou
authors.initials: WC
authors.lastname: Chang
authors.forename: Chin-Wang
authors.initials: CW
authors.lastname: Hsu
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Chen
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Tsai
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003710:Demography; D048909:Diabetes Complications / Q000097:blood* / Q000000981:diagnostic imaging; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D046290:Liver Abscess, Pyogenic / Q000097:blood* / Q000150:complications* / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D012372:ROC Curve; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin