Association of Multiple Glycemic Parameters at Hospital Admission with Mortality and Short-Term Outcomes in Acutely Poisoned Patients.

Catalina Lionte,Elisabeta Jaba,Inga Agafiti,Victorita Sorodoc,Cristina Bologa,Laurentiu Sorodoc,Ovidiu Rusalim Petris

doi:10.3390/diagnostics11020361

Abstract

The prognostic value of multiple glycemic parameters in poisoned patients was never assessed. We aim to explore the effects of glucose variability on short-term outcomes in nondiabetic and diabetic patients acutely poisoned with undifferentiated xenobiotics. We performed a prospective observational study in a tertiary center for toxicology in northeastern Romania. Over the course of 3 years, we included 1076 adults, older than 18 years, admitted for acute poisoning with a xenobiotic. The mortality rate was 4.1%. The admission blood glucose level (BGL) predicted mortality (OR 1.015, 95% CI 1.011–1.019, p < 0.001) and complications (OR 1.005, 95% CI 1.001–1.009, p 0.02). The mean glucose level (MGL) after admission (OR 1.007, 95% CI 1.000–1.013, p 0.034) and coefficient of glucose variability (CV) were predictive for complications (OR 40.58, 95% CI 1.35–1220.52, p 0.033), using the same multivariable model. The receiver operating characteristic curve (ROC) analysis revealed that BGL had good predictive value for in-hospital mortality (area under the curve (AUC) = 0.744, 95% CI = 0.648–0.841, p < 0.001), and complications (AUC = 0.618, 95% CI = 0.584–0.653, p < 0.001). In patients acutely poisoned with xenobiotics, the BGL, MGL and CV can be useful as mortality and short-outcome predictors.

Highlights

Hyper- and hypoglycemia are a common problem in hospitalized patients with or without a history of diabetes mellitus (DM) [1,2]
The present study aims to assess if admission blood glucose level (BGL) and glucose variability are associated with the short-term outcomes in both diabetic and nondiabetic acutely poisoned patients admitted within 12 h of exposure to a medical or intensive care unit (ICU) ward
Hyperglycemia and impaired admission glucose were associated with multiple complications during hospitalization, and we proved that higher glucose levels upon admission had a predictive value for the development of in-hospital complications

Summary

Introduction

Hyper- and hypoglycemia are a common problem in hospitalized patients with or without a history of diabetes mellitus (DM) [1,2]. Hyperglycemia proved to be associated with increased morbidity, mortality and poor outcomes in patients with an acute illness, such as coronary syndromes, pneumonia, or exacerbation of a chronic obstructive pulmonary disease [3,4,5]. Increased glucose variability was associated with longer hospitalization and mortality in both nondiabetic and diabetic patients, as well as with in-hospital complications following surgery [7,8]. We have not found any study on non-diabetic and diabetic patients following acute poisoning with undifferentiated xenobiotics to show multiple glycemic parameters with respect to poisoning severity score and outcome. The predictive value of multiple glycemic parameters for in-hospital mortality is unclear

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