title: Prognostic factors of mortality among patients with severe hyperglycemia.
abstract: OBJECTIVE
  Severe hyperglycemia is associated with increased morbidity and mortality in a variety of patients. We undertook this study to identify prognostic factors of mortality among patients experiencing severe hyperglycemia in the emergency department (ED).
  
  
  METHODS
  Longitudinal observation study.
  
  
  METHODS
  We recruited patients who visited the ED with blood glucose levels higher than 500 mg/dL between July 2008 and September 2010. The primary outcome was death from any cause within 90 days. Outcome analysis was first performed with Pearson's χ(2) test. Any characteristic with suspected significance (P < .1) was then used in a univariate Cox regression model. The variables found to be statistically significant were then subjected to multivariate analysis for further investigation.
  
  
  RESULTS
  Among 733 patients with severe hyperglycemia, the 90-day mortality rate was 14.6% (n = 107). Independent prognostic factors for increasing 90-day mortality included elevated absolute neutrophil count (hazard ratio [HR], 7.34), elevated C-reactive protein (HR, 4.48), elevated blood urea nitrogen (HR, 3.04), elevated respiratory rate (HR, 2.91), decreasing body temperature (HR, 2.68), decreasing systolic blood pressure (HR, 2.65), elevated potassium (HR, 2.54), decreasing blood glucose (HR, 2.46), elevated creatinine (HR, 2.40), elevated white blood cell count (HR, 2.30), and elevated ratio of blood urea nitrogen to creatinine (HR, 2.23).
  
  
  CONCLUSIONS
  The 90-day mortality rate among patients with severe hyperglycemia in the ED was 14.6%. Sepsis, renal impairment with electrolyte imbalance, and lower blood pressure were independent prognostic factors.
authors.forename: Ya-Wun
authors.initials: YW
authors.lastname: Guo
authors.forename: Tzu-En
authors.initials: TE
authors.lastname: Wu
authors.affiliation: Taipei Veterans General Hospital, No 201, Sec 2, Shih-Pai Rd, Taipei, Taiwan. E-mail: chenhs@vghtpe.gov.tw.
authors.forename: Harn-Shen
authors.initials: HS
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors
chemical_list: D001786:Blood Glucose