Predicting the hyperglycemic crisis death (PHD) score: a new decision rule for emergency and critical care

Am J Emerg Med. 2013 May;31(5):830-4. doi: 10.1016/j.ajem.2013.02.010. Epub 2013 Apr 18.


Background: We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups.

Methods: This study was done in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled when they met the criteria of a hyperglycemic crisis. Data were separated into derivation and validation sets-the former were used to predict the latter. December 31, 2008, was the cutoff date. Thirty-day mortality was the primary endpoint.

Results: We enrolled 295 patients who made 330 visits to the ED: derivation set = 235 visits (25 deaths: 10.6%), validation set = 95 visits (10 deaths: 10.5%). We found 6 independent mortality predictors: Absent tachycardia, Hypotension, Anemia, Severe coma, Cancer history, and Infection (AHA.SCI). After assigning weights to each predictor, we developed a Predicting Hyperglycemic crisis Death (PHD) score that stratifies patients into mortality-risk and disposition groups: low (0%) (95% CI, 0-0.02%): treatment in a general ward or the ED; intermediate (24.5%) (95% CI, 14.8-39.9%): the intensive care unit or a general ward; and high (59.5%) (95% CI, 42.2-74.8%): the intensive care unit. The area under the curve for the rule was 0.946 in the derivation set and 0.925 in the validation set.

Conclusions: The PHD score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in adult patients with hyperglycemic crises.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Critical Care
  • Decision Support Techniques*
  • Emergency Service, Hospital
  • Female
  • Health Status Indicators*
  • Hospitalization
  • Humans
  • Hyperglycemia / mortality*
  • Hyperglycemia / therapy
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prospective Studies
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Single-Blind Method