title: Admission blood glucose predicts mortality and length of stay in patients admitted through the emergency department.
abstract: BACKGROUND
  Hyperglycaemia has been associated with adverse outcomes in several different hospital populations.
  
  
  OBJECTIVE
  The aim of this study was to investigate the relationship between admission blood glucose level (BGL) and outcomes in all patients admitted through the emergency department.
  
  
  METHODS
  This study was a retrospective observational cohort study from an Australian tertiary referral hospital. Patients admitted in the first week of each month from April to October 2012 had demographic data, co-morbidities, BGL, intensive care unit admission, length of stay and dates of death recorded. Factors associated with outcomes were assessed by multi-level mixed-effects linear regression.
  
  
  RESULTS
  Admission BGL was recorded for 601 admissions with no diagnosis of diabetes and for 219 admissions diagnosed with type 2 diabetes (T2DM). In patients with no diagnosis of diabetes, admission BGL was associated with in-hospital and 90-day mortality (P < 0.001). After multivariate analysis, BGL greater than 11.5 mmol/L was significantly associated with increased mortality at 90 days (P < 0.05). In patients with T2DM increased BGL on admission was not associated with in-hospital or 90-day mortality but was associated with length of hospital stay (β: 0.22 days/mmol/L; 95% confidence interval 0.09-0.35; P < 0.001), although this association was lost on multivariable analysis. In patients with T2DM, increased coefficient of variation of BGL was also positively associated with length of hospital stay in an almost dose-dependent fashion (P < 0.001).
  
  
  CONCLUSIONS
  Admission BGL was independently associated with increased mortality in patients with no diagnosis of diabetes. Glycaemic variability was associated with increased length of hospital stay in patients with T2DM.
authors.affiliation: Department of Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: W G
authors.initials: WG
authors.lastname: Martin
authors.affiliation: Department of Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Galligan
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Simpson
authors.affiliation: Clinical Endocrinology, Royal Hobart Hospital, Hobart, Tasmania, Australia.|School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Greenaway
authors.affiliation: Endocrinology Laboratory, Royal Hobart Hospital, Hobart, Tasmania, Australia.|School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Burgess
mesh_terms: D000289:Admitting Department, Hospital / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013648:Tasmania / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose
keywords: diabetes; glycaemic variability; length of stay; mortality; stress hyperglycaemia