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

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.