title: Glycated hemoglobin at admission in the intensive care unit: clinical implications and prognostic relevance.
abstract: OBJECTIVE
  This study investigated the clinical significance of HbA1c levels on admission in the intensive care unit (ICU) as a prognostic marker for morbidity and mortality in critically ill patients.
  
  
  METHODS
  This prospective observational study included consecutive patients admitted in an 8-bed multidisciplinary ICU. Patients were prospectively followed from ICU admission until ICU outcome (death/discharge). All patients had an HbA1c measurement upon admission in the ICU.
  
  
  RESULTS
  Five hundred fifty-five consecutive patients (376 males, 179 females) were included in the study. In patients without prior diabetes mellitus (DM) diagnosis, a cutoff of 6.5% for HbA1c (diagnostic cutoff for DM) predicted more severe disease (as described by Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores at admission) and higher ICU mortality (adjusted odds ratio, 2.33; 95% confidence interval, 1.04-5.25). In the subgroup of patients with a history of DM, a cutoff of 7% for HbA1c (glycemic target) had no predicting ability for ICU mortality.
  
  
  CONCLUSIONS
  HbA1c is a useful tool for the diagnosis of a previously undiagnosed DM. This study showed that in critically ill patients with previously undiagnosed DM, HbA1c at admission is significantly associated with ICU mortality.
authors.affiliation: Intensive Care Unit, Thriassio General Hospital of Eleusis, Athens, Greece. Electronic address: mariakompoti@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Kompoti
authors.affiliation: Intensive Care Unit, Thriassio General Hospital of Eleusis, Athens, Greece.
authors.forename: Martha
authors.initials: M
authors.lastname: Michalia
authors.affiliation: Intensive Care Unit, Thriassio General Hospital of Eleusis, Athens, Greece.
authors.forename: Vaia
authors.initials: V
authors.lastname: Salma
authors.affiliation: Intensive Care Unit, Thriassio General Hospital of Eleusis, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Diogou
authors.affiliation: Department of Laboratory Hematology, Thriassio General Hospital of Eleusis, Athens, Greece.
authors.forename: Anthi
authors.initials: A
authors.lastname: Lakoumenta
authors.affiliation: Intensive Care Unit, Thriassio General Hospital of Eleusis, Athens, Greece.
authors.forename: Phyllis-Maria
authors.initials: PM
authors.lastname: Clouva-Molyvdas
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D016638:Critical Illness / Q000401:mortality; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes mellitus; Diagnostic criteria; Glycemic target; HbA1c; ICU mortality; Prediabetes