title: Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit.
abstract: OBJECTIVE
  Hyperglycemia is associated with increased mortality in cardiac patients. However, the predictive value of admission- and average glucose levels in patients admitted to an intensive cardiac care unit (ICCU) has not been described.
  
  
  METHODS
  Observational study of patients admitted to the ICCU of a tertiary medical center in whom glucose levels were measured at and during admission. Over a 19-month period, 1713 patients were included. Mean age was 63±14 years, 1228 (72%) were male, 228 (17%) had known diabetes. Median (interquartile) glucose levels at admission were 7.9 (6.5-10.1) mmol/l; median glucose levels during ICCU admission (873 patients with three or more measurements) were 7.3 (6.7-8.3) mmol/l. Cox regression analysis was performed including the variables age, gender, admission diagnosis, length of stay, prior (cardio)vascular disease and diabetes.
  
  
  RESULTS
  A 1 mmol/l increase in admission glucose level (above 9 mmol/l) was associated with a 10% (95% confidence interval (CI): 7 -13%) increased risk for all-cause mortality. A 1 mmol/l higher average glucose level (above 8 mmol/l) was an additional independent predictor of mortality (HR 1.11, 95% CI: 1.03 - 1.20). At 30 days, 16.8% (97/579) of the patients with an admission glucose level in the highest tertile (>9.8 mmol/L) had died vs 5.2% (59/1134) of those with a lower admission glucose level.
  
  
  CONCLUSIONS
  In a high risk ICCU population, both high admission glucose levels as well as high average glucose levels during hospitalization were independently associated with increased mortality, even when accounting for other risk factors and parameters of disease severity.
authors: Department of Cardiology, Erasmus Medical Center, The Netherlands.
authors: J A
authors: JA
authors: Lipton
authors: R J
authors: RJ
authors: Barendse
authors: R T
authors: RT
authors: Van Domburg
authors: A F L
authors: AF
authors: Schinkel
authors: H
authors: H
authors: Boersma
authors: M I
authors: MI
authors: Simoons
authors: K M
authors: KM
authors: Akkerhuis
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003325:Coronary Care Units; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D062606:Tertiary Care Centers
chemical_list: D001786:Blood Glucose
keywords: Glucose levels; acute coronary syndrome; intensive cardiac care; prognosis