Value Of Admission Blood Glucose Research Articles

Admission Blood Glucose and 2-Year Mortality After Acute Myocardial Infarction in Patients With Different Glucose Metabolism Status: A Prospective, Nationwide, and Multicenter Registry.

BackgroundThe prognostic effect of admission blood glucose (ABG) for patients with acute myocardial infarction (AMI) has not been well validated, especially in patients with diabetes. We performed this study to assess the predictive value of ABG for all-cause mortality in AMI patients with different glucose metabolism status.MethodsWe evaluated a total of 6,892 AMI patients from the prospective, nationwide, multicenter CAMI registry, of which 2,820 had diabetes, 2,011 had pre-diabetes, and 2,061 had normal glucose regulation (NGR). Patients were divided into high ABG and low ABG groups according to the optimal cutoff values of ABG to predict 2-year mortality for patients with diabetes, pre-diabetes and NGR, respectively. The primary endpoint was all-cause mortality.ResultsThe optimal cutoff values of ABG for predicting 2-year mortality was 9.0mmol/l, 7.2mmol/l and 6.2mmol/l for patients with diabetes, pre-diabetes and NGR, respectively. Overall, the risk of all-cause mortality in high ABG group was significantly increased compared with that in low ABG group among patients with diabetes (15.2% vs. 8.9%; hazard ratio [HR] 1.787, 95% confidence interval [CI] 1.413-2.260; P<0.0001), pre-diabetes (12.1% vs. 6.1%; HR 2.069, 95%CI 1.518-2.821; P<0.0001) and NGR (11.8% vs. 6.1%; HR 2.009, 95%CI 1.473-2.740; P<0.0001). After the potential confounders were adjusted, high ABG was significantly associated with higher risk of 2-year mortality in patients with diabetes (adjusted HR 1.710, 95%CI 1.327-2.203; P<0.0001), pre-diabetes (adjusted HR 1.731, 95%CI 1.249-2.399; P=0.001) and NGR (adjusted HR 1.529, 95%CI 1.110-2.106; P=0.009). Moreover, adding ABG to the original model led to a slight albeit significant improvement in C-statistic and net reclassification in patients with diabetes and NGR (all P<0.05).ConclusionsThis study is the first to demonstrate a strong positive association between ABG and 2-year mortality in AMI patients with diabetes, pre-diabetes and NGR. ABG should be considered as a useful marker for risk stratification in patients with diabetes and NGR. Further randomized trials are warranted to investigate the effects of blood glucose control on the reduction of long-term mortality according to the corresponding ABG thresholds for different glucose metabolism status.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT01874691.

High admission blood glucose independently predicts poor prognosis in COVID-19 patients: A systematic review and dose-response meta-analysis

AimsTo investigate the prognostic value of admission blood glucose (BG) in predicting COVID-19 outcomes, including poor composite outcomes (mortality/severity), mortality, and severity. MethodsEligible studies evaluating the association between admission fasting BG (FBG) and random BG (RBG) levels with COVID-19 outcomes were included and assessed for risk of bias with the Quality in Prognosis Studies tool. Random-effects dose-response meta-analysis was conducted to investigate potential linear or non-linear exposure-response gradient. ResultsThe search yielded 35 studies involving a total of 14,502 patients. We discovered independent association between admission FBG and poor COVID-19 prognosis. Furthermore, we demonstrated non-linear relationship between admission FBG and severity (Pnon-linearity < 0.001), where each 1 mmol/L increase augmented the risk of severity by 33% (risk ratio 1.33 [95% CI: 1.26–1.40]). Albeit exhibiting similar trends, study scarcity limited the evidence strength on the independent prognostic value of admission RBG. GRADE assessment yielded high-quality evidence for the association between admission FBG and COVID-19 severity, and moderate-quality evidence for its association with mortality and poor outcomes. ConclusionHigh admission FBG level independently predicted poor COVID-19 prognosis. Further research to confirm the prognostic value of admission RBG and to ascertain the estimated dose-response risk between admission FBG and COVID-19 severity are required.

Glycated hemoglobin, admission blood glucose delta, and associated mortality in patients with acute ST-segment elevation myocardial infarction

The importance of glucose metabolism in patients with acute coronary syndrome has been increasingly recognized. We conducted a retrospective study of the associations between prior glycated hemoglobin (HbA1c) levels, admission glucose values, HbA1c-derived estimated average glucose levels (eAG), admission glucose delta (admission glucose − eAG), and mortality in patients presenting with ST-segment elevation myocardial infarction. A total of 676 and 566 patients were included in the in-hospital and 12-month mortality models, respectively. Mean admission blood glucose values were higher in the in-hospital and 12-month mortality groups in patients with no prior diagnosis of diabetes (P < 0.001). Pre, post, and admission HbA1c levels and eAG levels were not associated with in-hospital or 12-month all-cause mortality. The admission glucose delta was higher in patients with in-hospital mortality (87.3 ± 122.7 mg/dL) than in patients who survived (35.88 ± 81.23 mg/dL; P = 0.040). The in-hospital death rate was significantly higher (17% vs 4%, P = 0.017) for patients with admission glucose delta ≥140 mg/dL compared to lower values. In conclusion, HbA1c-derived admission glucose delta is associated with in-hospital mortality in patients with ST-segment elevation myocardial infarction. The mechanisms for the association of acute hyperglycemia with increased acute coronary syndrome mortality are unclear.

Prognostic Value of Admission Blood Glucose in Diabetic and Non-diabetic Patients with Intracerebral Hemorrhage.

We aimed to validate prognostic value of elevated admission blood glucose (ABG) for clinical outcomes in diabetic and non-diabetic patients with intracerebral hemorrhage (ICH) in a representative large cohort. Data of ICH patients with onset time ≤24 h were derived from the China National Stroke Registry. Clinical outcomes included 3-month poor outcome (death or dependency) and death. Logistic regression was performed for the association between ABG and clinical outcomes, both in the entire cohort and in patients with and without diabetes mellitus. 2951 ICH patients were enrolled, including 267 (9.0%) diabetics. In the entire cohort, there was a trend to increased risk of poor outcome with increasing ABG levels (adjusted OR 1.09; 95% CI, 1.04–1.15; P < 0.001). The risk of poor outcome was significantly greatest for the highest quartile (≥7.53 mmol/L) of ABG (adjusted OR 1.54; 95% CI, 1.17–2.03; p = 0.002, P for trend 0.004). We got similar association in non-diabetics but not in diabetics. Elevated ABG confers a higher risk of poor outcome in non-diabetics than diabetics with similar glucose level. Elevated ABG is an independent predictor of 3-month poor outcome in ICH patients, the prognostic value of which is greater in non-diabetics than diabetics with similar glucose level.

Admission hyperglycemia is associated with failed reperfusion following fibrinolytic therapy in patients with STEMI: results of a retrospective study.

Hyperglycemia on admission is associated with increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) who are treated with either fibrinolytic therapy (FT) or primary percutaneous coronary intervention (PCI). However, data regarding the relationship between hyperglycemia and the success of FT are lacking. The aim of this study was to investigate the value of admission blood glucose for the prediction of failed reperfusion following FT. This is a retrospective study of 304 STEMI patients who received FT and whose admission glucose levels were recorded. The main outcome measure was ST segment resolution≥50%. The median (interquartile range [IQR]) blood glucose level in the entire study group was 112 (95-153). In 92 (30.2%) patients, FT was unsuccessful and rescue PCI was performed. Admission glucose (126 [99-192] vs. 110 [94-144] mg/dL, p<0.001), time from symptom onset to FT (180 [120-270] vs. 150 [120-180] min, p=0.009), and maximum ST elevation amplitude (3 [2-7] vs. 3 [2-6] mm, p=0.05) were higher in the failed reperfusion group than in the reperfusion group. Admission hyperglycemia was an independent predictive factor for failed reperfusion (hazard ratio 4.79 [1.80-12.76], p=0.002), along with time from symptom onset to fibrinolysis and anterior wall myocardial infarction. In patients with STEMI who undergo FT, admission hyperglycemia is an independent predictor of the failure of fibrinolysis.

Incremental value of admission blood glucose on top of GRACE risk score in patients with acute coronary syndromes

Background: Abnormal glucose metabolism is a predictor of worst outcome after Acute Coronary Syndrome (ACS). However, this parameter (or the presence of diabetes), isn't included in the most recently risk prediction scores, including GRACE risk score. We sought to evaluate if the inclusion of blood glucose on admission in a model with GRACE risk score improves risk stratification. Methods: Study of consecutive patients included in a single centre registry of ACS. We clinical and laboratorial variables as well as treatment provided. Primary endpoint was the occurrence of all-cause mortality at one-year follow-up. The ideal cut-off of blood glucose to predict the outcome was obtained by receiver-operating characteristics (ROC) curve analysis. Predictive value of high blood glucose was assessed by Cox regression analysis. The incremental predictive value was analysed with ROC curve, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) of logistic regression models obtained with GRACE risk score alone and after the inclusion of blood glucose. Results: We included 2099 patients, mean age of 64±13 years, 69% males. In our population, 55.1% presented with ST-segment elevation ACS and 13.1% in Killip class ≥ 2. Only 25% were known diabetic at admission. In-hospital mortality was 5.8% and 9.7% at one-year follow-up. The best cut-off for blood glucose was 160 mg/dL (sensitivity 62% and specificity 68%), and 35.2% of the patients had increased levels. This group was elderly, had more prevalence of cardiovascular risk factors, worst renal function and GRACE score as well as more frequently Killip class ≥2. Treatment was similar in both groups but the hyperglycemia group had higher in-hospital mortality (11.2% vs. 2.8%) and at one-year follow-up (17.2% vs. 5.6%, Log-rank, p<0.001). Hyperglycemia on admission is a predictor of death independently of the GRACE risk score and the presence of diabetes (HR 1.89, 95% CI 1.38 – 2.58, p<0.001). Inclusion of this parameter in a regression model with GRACE score increased the Area Under Curve from 0.804 to 0.816 (p=0.038). The new model was associated with an improvement in both the Net Reclassification Improvement (NRI = 60%) and the Integrated Discrimination Improvement (IDI = 0.015) suggesting effective reclassification. Conclusions: A blood glucose level on admission ≥ 160 mg/dL is an independent predictor of mortality in medium-term follow-up. It offers an incremental predictive value on top of GRACE risk score, although with a modest magnitude of improvement, probably due to the high predictive power of GRACE risk score alone.

3 Survival following acute myocardial infarction in patients of South Asian and White European ethnicity in the UK

IntroductionSome UK studies have suggested higher case-fatality rates following acute myocardial infarction (AMI) in British South Asian (SA), compared to white European (WE) people, driven by higher prevalence of diabetes...

Implications of hyperglycaemia and ethnicity in patients with acute coronary syndromes in New Zealand

Admission blood glucose (ABG) is an independent predictor of death in patients with acute ST elevation myocardial infarction (STEMI). In New Zealand, mortality following myocardial infarction is disproportionally higher in Maori. Little information, however, exists concerning the predictive value of ABG in non-ST elevation acute coronary syndromes (NSTEACS) events or indeed if similar ethnic differences exist in outcome in this patient population. To assess the predictive value of ABG and ethnicity in individuals admitted with acute coronary syndromes (ACS) on mortality. A retrospective analysis of hospital discharge diagnosis of all ACS between 1 January 1999 and 31 December 2002 at Waikato hospital, Hamilton, New Zealand. The primary outcome was all-cause mortality. There were 4408 episodes of ACS with 1091 (25%) due to STEMI. There were 806 (18%) deaths. The presence of diabetes mellitus (DM) or an elevated ABG, in the absence of a history of DM, was associated with poor patient outcome. Early mortality is seen in individuals presenting with STEMI. People in the highest glucose category were older, more likely to be Maori, had a higher percentage of people with diabetes and remained in hospital longer, regardless of ACS type, than those in the lowest glucose category. Diabetes was more common in Maori (33%) than in Europeans (17.5%); p < 0.001. Significant risk factors for mortality were age, gender, diabetes, ethnicity, glucose and STEMI. For each mmol/l increase in glucose there is a 4.3% increase risk of dying. Adjusting for age and gender, Maori have a much higher mortality than Europeans (RR 2.12; p < 0.00001) regardless of ACS type (STEMI or NSTEACS). Our study confirms the higher mortality following ACS, of Maori compared to New Zealanders of European origin. A raised ABG is a marker of this increased risk in all patients with ACS.

Relationship between hyperglycemia and symptomatic vasospasm after subarachnoid hemorrhage*

To determine the relationship between blood glucose levels (mg/dL) and occurrence of symptomatic vasospasm (VSP) and clinical outcomes after aneurysmal subarachnoid hemorrhage. Retrospective observational study of 352 patients with subarachnoid hemorrhage admitted within 48 hrs of ictus between January 1995 and June 2002. Neurointensive care unit. Adult patients admitted after subarachnoid hemorrhage. None. Variables included age; Hunt-Hess classification score; Fisher group; insulin use; infectious disease status; history of diabetes mellitus; and blood glucose values. Poor clinical outcome was defined by a modified Rankin score > or =3, and hyperglycemia was defined by a blood glucose level >140 mg/dL. Mean daily blood glucose values were assessed from admission to development of VSP or day 14. Mean admission blood glucose value, mean inpatient blood glucose value, insulin use, infectious disease status, Hunt-Hess classification score, Fisher group, and history of diabetes mellitus were entered in a Cox proportional hazards model. VSP occurred in 103 (29.2%) of 352 patients. Mean admission blood glucose values (176.6 +/- 40.3 mg/dL vs. 162.3 +/- 47.8 mg/dL; p = .01) and mean inpatient blood glucose values (166.2 +/- 24.7 mg/dL vs. 155.8 +/- 29.7 mg/dL; p = .001) were significantly higher in patients with VSP. Mean inpatient blood glucose value (relative risk, 1.01; 95% confidence interval, 1.0-1.03; p = .04), Hunt-Hess classification score > or =3 (relative risk, 2.23; 95% confidence interval, 1.21-3.99; p = .02), and Fisher group score of 3 (relative risk, 1.28; 95% confidence interval, 1.15-3.1; p = .05) increased the risk for VSP. Hyperglycemia was associated with longer length of stay in the neurointensive care unit (14.5 +/- 7.1 days vs. 11.6 +/- 5.4 days; p < .001) and poor outcome at discharge (modified Rankin score > or =3: 58.9% vs. 18.8%; p < .001). Mean inpatient blood glucose value is associated with the development of VSP and may represent a target for therapy to prevent VSP and improve clinical outcomes.

Effects of sliding scale insulin use on glycemic control and length of stay in hospitalized patients with Type 2 diabetes mellitus

Objectives: To assess the effect of sliding scale insulin (SSI) use on glycemic control and length of hospital stay in patients with diabetes mellitus. Methods: A prospective cohort study of 182 patients with diabetes mellitus as a primary diagnosis or a comorbid condition admitted consecutively to the internal medicine wards over a 6-week period. Demographic, clinical and laboratory data were collected from in-patient medical records. Data were analyzed using Chi-square and independent t-tests and presented as the mean ± standard error of the mean. Results: Of the total 182 in-patients with Type 2 diabetes, 130 (71.4%) were placed on SSI (Group A) and 52 (28.6%) on standing-dose antihyperglycemic therapy without the use of SSI (Group B). While there was no difference in admission blood glucose values (mg/dl) between Group A (236 ± 14.3) and Group B (237 ± 6.4), higher average in-hospital fasting blood glucose values were recorded from Group A (168 ± 7.2) compared with Group B (139 ± 11.5), p = 0.04. Plasma glucose values at discharge were not significantly different between the two groups with an average of 172 ± 8.1 for Group A and 170 ± 18.1 for Group B. Also, there was no significant difference in the number of days of hospitalization between the two groups with an average of (7.6 ± 0.89) for Group A and (10 ± 4.7) for Group B. Conclusion: SSI use is associated with higher in-hospital blood glucose and does not offer any advantage in terms of duration of hospital stay as compared with standard-dose antihyperglycemic therapy.

Modifying cardiovascular risk in diabetes mellitus.

DIABETES mellitus affects an estimated 35 million people in the United States, and the disease prevalence is predicted to increase by nearly 200% in the next several decades. As a result, anesthesiologists will be confronted with an increasing population of patients undergoing anesthesia and surgery who are at risk for ischemic heart disease. Hyperglycemia Predicts Cardiovascular Risk Diabetes is a significant predictor of perioperative cardiovascular morbidity and mortality, but few studies have evaluated methods to modify this risk. Compelling evidence indicates that aggressive management of diabetes may substantially decrease the adverse consequences of myocardial ischemia and infarction. The direct impact of hyperglycemia on cardiovascular mortality in patients with and without diabetes is a central theme of current research, and several investigations conducted during the past 20 yr demonstrated that mortality resulting from acute myocardial infarction (AMI) is increased if blood glucose concentration is elevated at the time of hospital admission. 1 These findings were confirmed in a recent prospective analysis of 336 consecutive patients admitted with AMI. 2 One-year mortality was 9% for patients with AMI and normal admission blood glucose values. In contrast, patients with hyperglycemia (blood glucose concentrations of 121 15, 168 13, and 282 65 mg/dl) on admission demonstrated substantial increases (P 0.005) in mortality to 13, 30, and 44%, respectively. 2 The Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) trial addressed the prognostic significance of hyperglycemia in patients with type 1 and 2 diabetes and AMI. 3 A nearly linear relationship between blood glucose concentration on admission and long-term mortality was observed in conventionally treated patients in this randomized clinical trial (mortality rates of 35, 40, and 55% at blood glucose concentrations of 235, 235–298, and 298 mg/dl, respectively). A direct relationship between fasting blood glucose concentration and the risk of sustaining a cardiovascular event (e.g., sudden cardiac death, AMI, or cerebrovascular accident) has been demonstrated in a meta-regression analysis of data from 20 studies involving more than 95,000 patients. 4 The risk associated with fasting blood glucose concentrations was linear and extended below the threshold used to define diabetes. A fasting blood glucose value of only 110 mg/dl was associated with an increased relative risk of a cardiovascular event. Similarly, the odds ratio of AMI was increased to 1.5, 3.4, and 6.0 at fasting blood glucose concentrations of approximately 90, 110, and greater than 115 mg/dl, respectively. 5 Another large cohort study indicated that glycosylated hemoglobin (HbA1c) concentration, but not the presence of diabetes, predicted an increase in mortality. 6 The risk of all-cause mortality increased by a factor of 1.46 for every 1% increase in HbA 1c when male patients with diabetes, those with HbA 1c concentrations greater than 7%, or patients with a history of heart disease or stroke were excluded from the multivariate regression model. Similarly, creatinine kinase concentrations were higher in patients with hyperglycemia admitted with AMI compared with those with normal blood glucose levels. 2 These data demonstrate a striking relationship