title: Cancer history, bandemia, and serum creatinine are independent mortality predictors in patients with infection-precipitated hyperglycemic crises.
abstract: BACKGROUND
  Infection is the most common precipitating factor and cause of death in patients with hyperglycemic crises. Treating infection-precipitated hyperglycemic crises includes using empiric antibiotics early; correcting dehydration, hyperglycemia, and electrolyte imbalances; and frequent monitoring. Intensive care unit admission, broad-spectrum antibiotics, and even novel therapy for infection may be beneficial for patients with a high risk of mortality. However, these management options are costly and not beneficial for every patient. Selecting high-risk patients who would most likely benefit is more appropriate. We investigated the independent mortality predictors of patients with infection-precipitated hyperglycemic crises to facilitate clinical decision making.
  
  
  METHODS
  This study was conducted in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the Emergency Department between January 2004 and December 2010 were enrolled when they met the criteria of an infection-precipitated hyperglycemic crisis. Thirty-day mortality was the primary endpoint.
  
  
  RESULTS
  One hundred forty-two patients were enrolled. The infection source did not predict mortality. The presenting variables that were independently associated with 30-day mortality in a multiple logistic regression model were cancer history (odds ratio [OR], 7.4; 95% confidence interval [CI], 2.4-23.2), bandemia (OR, 7.0; 95% CI, 1.6-30.3), and serum creatinine (OR, 1.4; 95% CI, 1.1-1.8). The common sources of infection were the lower respiratory tract (30.3%), urinary tract (49.3%), skin or soft tissue (12.0%), and intra-abdominal (6.3%).
  
  
  CONCLUSIONS
  Cancer history, bandemia, and serum creatinine level are three independent mortality predictors for patients with infection-precipitated hyperglycemic crises. These predictors are both readily available and valuable for physicians making decisions about risk stratification, treatment, and disposition.
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Willy
authors.initials: W
authors.lastname: Chou
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.forename: Shih-Chung
authors.initials: SC
authors.lastname: Chen
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Kuo
authors.forename: Wei-Lung
authors.initials: WL
authors.lastname: Chen
authors.forename: Jiann-Hwa
authors.initials: JH
authors.lastname: Chen
authors.forename: Hsien-Yi
authors.initials: HY
authors.lastname: Wang
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo