Background: Hyperglycemia is a common finding in emergency department (ED) patients, but its general relevance for the further clinical course has not been determined as yet.
Objectives: To examine the prevalence of hyperglycemia, its consequence on in-hospital outcome in emergency patients as well as ED hyperglycemia management.
Materials and methods: Blood glucose levels (BGL) were routinely measured in every hospitalized ED patient. Hyperglycemia was defined as BGL of at least 140 mg/dl at arrival to the ED. According to the recommendations of the American Diabetes Association, patients were divided into three groups: normoglycemia: 60-140 mg/dl, hyperglycemia with a need for follow-up: 140-179 mg/dl, and hyperglycemia with the need for intervention (HGI): at least 180 mg/dl. Multiple regression models adjusted for potential confounders were used to estimate the association between BGL elevation and mortality and length of hospital stay.
Results: The prevalence of hyperglycemia was high (n=849, 21%), with 400 patients presenting HGI (47% of patients in the hyperglycemic group). The in-hospital mortality rate was higher in both hyperglycemic groups combined [odds ratio (OR) 1.92; 95% confidence interval (CI): 1.34-2.77], with the highest OR in patients presenting HGI (OR 2.32; 95% CI: 1.43-3.23). Patients with hyperglycemia showed an increased length of hospital stay [estimated mean +1.67 days (95% CI: 1.02-2.33)] as well as an increased risk for ICU admission (OR 1.73; 95% CI: 1.33-2.25). Analysis of ED hyperglycemia management showed low rates of insulin treatment (14% of HGI group) and a lack of hyperglycemia communication in ED-referral letters.
Conclusion: ED hyperglycemia was found to be a strong predictor of in-hospital outcome, whereas responding ED management was inadequate. Further prospective studies are needed to determine whether systematic ED hyperglycemia management could improve outcomes.