The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study.
The clinical relevance of hyperglycaemia in an emergency department population remains incompletely understood. We investigated the association between admission blood glucose levels and adverse clinical outcomes in a large emergency department cohort.



We prospectively enrolled 7132 adult medical patients seeking emergency department care in three tertiary care hospitals in Switzerland, France and the USA. We used adjusted multivariable logistic regression models to examine the association between admission blood glucose levels and 30-day mortality, as well as adverse clinical course stratified by pre-existing diabetes and principal medical diagnoses.



In 6044 people without diabetes (84.7%), severe hyperglycaemia, defined as a glucose level of > 11.1 mmol/l (200 mg/dl), was associated with a doubling in the risk of 30-day mortality [adjusted odds ratio (OR) 1.9; 95% confidence interval (95% CI), 1.1 to 3.3; P = 0.018] and a three-fold increase in the risk of intensive care unit admission (adjusted OR 3.0; 95% CI, 1.9 to 4.9; P < 0.001). These associations were similar among different diagnoses. In the population with diabetes (n = 1088), no association with 30-day mortality was found (adjusted OR 1.0; 95% CI, 0.6 to 1.8; P for interaction = 0.001), whereas the association with intensive care unit admission was weaker (adjusted OR 2.4; 95% CI, 1.5 to 4.1; P for interaction = 0.011). Overall 30-day mortality was higher in those with diabetes than in those without (6.1 vs. 4.4%, P = 0.015).



In this large medical emergency department patient cohort, admission hyperglycaemia was strongly associated with adverse clinical course in people without diabetes. (Clinical Trial Registry No: NCT01768494).
Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
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A
Kutz
Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
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Struja
Emergency Department, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.|Sorbonne Universités UPMC-Univ Paris 06, UMRS INSERM 1166, IHUC ICAN, Paris, France.
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Hausfater
Morton Plant Hospital, Clearwater, Florida, USA.
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Amin
Morton Plant Hospital, Clearwater, Florida, USA.
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Amin
Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
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Haubitz
Biochemistry Department, Hôpital Pitié-Salpêtrière and Univ-Paris Descartes, Paris, France.
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Bernard
Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
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Huber
Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
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B
Mueller
Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
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Schuetz
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology; D062606:Tertiary Care Centers; D014481:United States / Q000453:epidemiology
D001786:Blood Glucose