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Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit.
Eur Heart J Acute Cardiovasc Care. 2013 Dec; 2(4):306-13.EH

Abstract

AIMS

Hyperglycemia is associated with increased mortality in cardiac patients. However, the predictive value of admission- and average glucose levels in patients admitted to an intensive cardiac care unit (ICCU) has not been described.

METHODS

Observational study of patients admitted to the ICCU of a tertiary medical center in whom glucose levels were measured at and during admission. Over a 19-month period, 1713 patients were included. Mean age was 63±14 years, 1228 (72%) were male, 228 (17%) had known diabetes. Median (interquartile) glucose levels at admission were 7.9 (6.5-10.1) mmol/l; median glucose levels during ICCU admission (873 patients with three or more measurements) were 7.3 (6.7-8.3) mmol/l. Cox regression analysis was performed including the variables age, gender, admission diagnosis, length of stay, prior (cardio)vascular disease and diabetes.

RESULTS

A 1 mmol/l increase in admission glucose level (above 9 mmol/l) was associated with a 10% (95% confidence interval (CI): 7 -13%) increased risk for all-cause mortality. A 1 mmol/l higher average glucose level (above 8 mmol/l) was an additional independent predictor of mortality (HR 1.11, 95% CI: 1.03 - 1.20). At 30 days, 16.8% (97/579) of the patients with an admission glucose level in the highest tertile (>9.8 mmol/L) had died vs 5.2% (59/1134) of those with a lower admission glucose level.

CONCLUSION

In a high risk ICCU population, both high admission glucose levels as well as high average glucose levels during hospitalization were independently associated with increased mortality, even when accounting for other risk factors and parameters of disease severity.

Authors+Show Affiliations

Department of Cardiology, Erasmus Medical Center, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

24338289

Citation

Lipton, J A., et al. "Hyperglycemia at Admission and During Hospital Stay Are Independent Risk Factors for Mortality in High Risk Cardiac Patients Admitted to an Intensive Cardiac Care Unit." European Heart Journal. Acute Cardiovascular Care, vol. 2, no. 4, 2013, pp. 306-13.
Lipton JA, Barendse RJ, Van Domburg RT, et al. Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit. Eur Heart J Acute Cardiovasc Care. 2013;2(4):306-13.
Lipton, J. A., Barendse, R. J., Van Domburg, R. T., Schinkel, A. F., Boersma, H., Simoons, M. I., & Akkerhuis, K. M. (2013). Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit. European Heart Journal. Acute Cardiovascular Care, 2(4), 306-13. https://doi.org/10.1177/2048872613489304
Lipton JA, et al. Hyperglycemia at Admission and During Hospital Stay Are Independent Risk Factors for Mortality in High Risk Cardiac Patients Admitted to an Intensive Cardiac Care Unit. Eur Heart J Acute Cardiovasc Care. 2013;2(4):306-13. PubMed PMID: 24338289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit. AU - Lipton,J A, AU - Barendse,R J, AU - Van Domburg,R T, AU - Schinkel,A F L, AU - Boersma,H, AU - Simoons,M I, AU - Akkerhuis,K M, Y1 - 2013/05/09/ PY - 2013/12/17/entrez PY - 2013/12/18/pubmed PY - 2014/9/3/medline KW - Glucose levels KW - acute coronary syndrome KW - intensive cardiac care KW - prognosis SP - 306 EP - 13 JF - European heart journal. Acute cardiovascular care JO - Eur Heart J Acute Cardiovasc Care VL - 2 IS - 4 N2 - AIMS: Hyperglycemia is associated with increased mortality in cardiac patients. However, the predictive value of admission- and average glucose levels in patients admitted to an intensive cardiac care unit (ICCU) has not been described. METHODS: Observational study of patients admitted to the ICCU of a tertiary medical center in whom glucose levels were measured at and during admission. Over a 19-month period, 1713 patients were included. Mean age was 63±14 years, 1228 (72%) were male, 228 (17%) had known diabetes. Median (interquartile) glucose levels at admission were 7.9 (6.5-10.1) mmol/l; median glucose levels during ICCU admission (873 patients with three or more measurements) were 7.3 (6.7-8.3) mmol/l. Cox regression analysis was performed including the variables age, gender, admission diagnosis, length of stay, prior (cardio)vascular disease and diabetes. RESULTS: A 1 mmol/l increase in admission glucose level (above 9 mmol/l) was associated with a 10% (95% confidence interval (CI): 7 -13%) increased risk for all-cause mortality. A 1 mmol/l higher average glucose level (above 8 mmol/l) was an additional independent predictor of mortality (HR 1.11, 95% CI: 1.03 - 1.20). At 30 days, 16.8% (97/579) of the patients with an admission glucose level in the highest tertile (>9.8 mmol/L) had died vs 5.2% (59/1134) of those with a lower admission glucose level. CONCLUSION: In a high risk ICCU population, both high admission glucose levels as well as high average glucose levels during hospitalization were independently associated with increased mortality, even when accounting for other risk factors and parameters of disease severity. SN - 2048-8734 UR - https://www.unboundmedicine.com/medline/citation/24338289/Hyperglycemia_at_admission_and_during_hospital_stay_are_independent_risk_factors_for_mortality_in_high_risk_cardiac_patients_admitted_to_an_intensive_cardiac_care_unit_ L2 - http://journals.sagepub.com/doi/full/10.1177/2048872613489304?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -