Blood Glucose at Admission Could Serve as Prognostic Marker in Emergency Departments

Data from a retrospective analysis of emergency department visits in Sweden from a decade-long period suggests random glucose level measurements at admission could serve as a prognostic marker for all-cause mortality and cardiovascular disease among people without diabetes.

Using data from more than 600,000 patients with a mean follow-up of 3.9 years, results of the study demonstrate patients with disturbed blood glucose were at a greater mortality risk, with a hyperglycemia associated with a 2-fold increase in long-term mortality and a more than doubling in risk of cardiovascular events compared to their normoglycemic counterparts.

“The present result from this large observational study confirms earlier short-, and long-term studies but also suggests that a random blood glucose level at admission predicts death and cardiovascular outcome in patients without known diabetes at a long follow-up period,” wrote investigators.

Conducted by a team from Karolinska Institutet and Karolinska University Hospital, the current research endeavor was undertaken as with the intent of exploring whether elevated blood glucose levels could predict cardiovascular disease and all-cause mortality risk in people without a history of diabetes. With this in mind, investigators designed their study as a retrospective cohort study of patient data recorded from 2006-2016 obtained from a group of 7 hospitals in Stockholm and Gothenburg, Sweden.

Using only the first visit emergency department visit for each individual, investigators identified 618,694 patients with a mean follow-up time of 3.9 years for inclusion in their analysis. Based on baseline blood glucose level patients were categorized into four groups: hypoglycemia (less than 3.9 mmol/L), normal glucose tolerance (3.9-7.8 mmol/L), dysglycemia (7.8-11.1 mmol/L), and hyperglycemia (greater than 11.1 mmol/L). Using this as the exposure of interest, investigators used Cox regression to estimate risk of all-cause mortality and cardiovascular outcomes across these groups.

Of the 618,694 patients included in the study, 0.3% had hypoglycemia, 85% had normal glucose tolerance, 13% had dysglycemia, and 2% patients had hyperglycemia. During the follow-up period, a total of 44,532 deaths occurred among the study cohort. Of these 44,532 patient deaths, 11.5% had hypoglycemia, 6.0% had normal glucose tolerance, 12.7% had dysglycemia, and 20.6% patients had hyperglycemia.

When assessing for risk of all-cause mortality, an increased risk was observed for those with hypoglycemia (HR, 2.58 [95% CI, 2.26-2.96]), hyperglycemia (HR, 1.69 [95% CI, 1.63-1.76]) and dysglycemia (HR 1.16 [95% CI, 1.13-1.19]) when compared to their counterparts with normal glucose tolerance. When assessing for risk of cardiovascular disease events, a more than doubling in risk was observed for hyperglycemia (HR, 2.28 [95% CI, 2.13-2.44]) compared to those with normal glucose tolerance.

“This indicates that a random blood glucose in the ED can help identify patients at risk and further controlled studies to improve their outcome should be considered,” investigators concluded.

This study, “Admission glucose as a prognostic marker for all‑cause mortality and cardiovascular disease,” was published in Cardiovascular Diabetology.