Emergency department glucose cut-off for 2-year mortality: A multicentre, prospective, cohort study.

IF 4.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Carmen Barbero Linares, José Luis Martín-Conty, Begoña Polonio-López, Cristina Rivera Picón, Juan J Bernal-Jiménez, Francisca Torres Falguera, Joseba Rabanales Sotos, Miguel Antonio Sampedro-Nuñez, Fernando Sebastián-Valles, Miguel Ángel Castro Villamor, Carlos Del Pozo Vegas, Marta Pérez González, Raúl López-Izquierdo, Francisco Martín-Rodríguez, Ancor Sanz-García
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Abstract

Introduction: Admission glucose levels in acute illnesses are critical prognostic biomarkers; yet their impact on long-term outcomes has not been sufficiently studied, particularly in emergency medical services (EMS). This study aims to establish specific glucose cut-off points to predict 2-year mortality in patients treated in emergency departments (ED), stratified by diabetes status (Nondiabetic, Uncomplicated diabetes and Complicated diabetes).

Methods: A multicentre, prospective cohort study was conducted, including 5632 adult patients with acute illnesses managed by EMS and admitted to EDs in three Spanish provinces. Patients were classified as nondiabetic, with uncomplicated diabetes, or with diabetes with complications. Multivariable analyses were used to identify predictors of 2-year mortality and determine specific glucose cut-off points.

Results: In nondiabetic patients, admission glucose levels showed a U-shaped relationship with 2-year mortality, with key cut-off points at 76.1 and 143 mg/dL. Conversely, no significant association between glucose levels and mortality was observed in diabetic patients. Predictors of mortality included advanced age, high aCCI scores and organ dysfunction in nondiabetics, while diabetic patients exhibited additional alterations related to chronic inflammation and coagulation.

Conclusion: Admission glucose levels are a key biomarker for predicting 2-year mortality in nondiabetic patients treated in EDs, emphasizing the importance of maintaining glucose within optimal ranges. These findings support the development of personalised management strategies based on the metabolic and clinical status of patients, optimising resources and outcomes in EMS and EDs.

急诊科2年死亡率的血糖临界值:一项多中心、前瞻性队列研究。
急性疾病患者入院时血糖水平是重要的预后生物标志物;然而,它们对长期结果的影响尚未得到充分研究,特别是在紧急医疗服务方面。本研究旨在建立特定的血糖临界值,以预测在急诊科(ED)接受治疗的患者的2年死亡率,并按糖尿病状态(非糖尿病、非并发症糖尿病和并发症糖尿病)进行分层。方法:采用一项多中心前瞻性队列研究,纳入西班牙三个省的5632例急诊急诊急诊急诊成人急性病患者。患者被分为非糖尿病、无并发症糖尿病和合并并发症糖尿病。多变量分析用于确定2年死亡率的预测因子,并确定特定的葡萄糖临界值。结果:在非糖尿病患者中,入院血糖水平与2年死亡率呈u型关系,关键临界值为76.1和143 mg/dL。相反,在糖尿病患者中,血糖水平与死亡率之间没有明显的联系。非糖尿病患者的死亡预测因素包括高龄、高aCCI评分和器官功能障碍,而糖尿病患者表现出与慢性炎症和凝血相关的额外改变。结论:入院血糖水平是预测急诊非糖尿病患者2年死亡率的关键生物标志物,强调了将血糖维持在最佳范围内的重要性。这些发现支持了基于患者代谢和临床状态的个性化管理策略的发展,优化了EMS和EDs的资源和结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.50
自引率
3.60%
发文量
192
审稿时长
1 months
期刊介绍: EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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