title: Prognostic Value of Glycated Hemoglobin for One Year Mortality Following Hospitalization in the Internal Medicine Ward.
abstract: BACKGROUND
  The impact of admission glycated hemoglobin (HbA1c) on hospital outcome is controversial.
  
  
  OBJECTIVE
  To evaluate the association between admission glucose and HbA1c levels and mortality 1 year after hospitalization in the internal medicine ward.
  
  
  METHODS
  HbA1c level of consecutive patients was measured during the first 24 hours of admission to the internal medicine ward and divided at the cutoff point of 6.5%. Three groups of patients were prospectively identified: patients with preexisting diabetes mellitus (DM), patients with glucose > 140 mg/dl (hyperglycemia) on admission and no known diabetes (H), and patients without diabetes or hyperglycemia (NDM). The primary end-point was 1 year all-cause mortality.
  
  
  RESULTS
  A total of 1024 patients were enrolled, 592 (57.8%) belonged to the DM group, 119 (11.6/6) to the H group and 313 (30.6%) to the NDM group. At 1 year, death occurred in 70 (11.9%) in the DM group, 12 (10.0%) in the H group and 15 (4.8%) in the NDM group (P = 0.002). Elevated admission glucose levels did not influence outcome in any of the groups. HbA1c levels were similar for survivors and non-survivors (P = 0.60). Within-group multivariate analysis adjusted for comorbidities and age showed that in the H group HbA1C levels of 6.5% or above were associated with increased mortality risk [hazard ratio (HR) 8.25, 95% confidence interval (CI) 1.93-35.21]. In the DM group, HbA1c levels below 6.5% were associated with increased mortality risk (HR = 2.05, 95% CI 1.25-3.36).
  
  
  CONCLUSIONS
  Glucose levels upon admission did not affect mortality. However, HbA1c levels below 6.5% had opposite effects on 1 year mortality in diabetes patients and patients with hyperglycemia.
authors.forename: Idit F
authors.initials: IF
authors.lastname: Liberty
authors.forename: Naim
authors.initials: N
authors.lastname: Abu Freha
authors.forename: Yael
authors.initials: Y
authors.lastname: Baumfeld
authors.forename: Shlomi
authors.initials: S
authors.lastname: Codish
authors.forename: Fransisc
authors.initials: F
authors.lastname: Schlaeffer
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000401:mortality; D007388:Internal Medicine / Q000379:methods; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin