Predictive Value of HbA1c-levels with Regard to In-hospital Mortality, Length of Hospital Stay and Intensive Care Utilisation versus Different Emergency Risk Scores and the Manchester Triage System in Unselected Medical Emergency Admissions
1Private Practice,Hildegard-von-Bingen-Str. 1, 93053 Regensburg, Germany
2Private Practice, Rupertistraße 11A, 84518 Garching an der Alz, Germany
3Department of Emergency Medicine, RoMed Clinical Centre Rosenheim, Rosenheim, Germany
4Department of Internal Medicine II, RoMed Clinical Centre Rosenheim, Rosenheim, Germany
5Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre Rosenheim, Rosenheim, Germany
DOI: 10.22514/sv.2020.16.0006 Vol.16,Issue 1,June 2020 pp.39-45
Published: 30 June 2020
Objectives: To evaluate the predictive value of HbA1c levels in medical patients admitted to the emergency department (ED) regarding in-hospital-mortality, length of stay (LOS) and transferral to intensive care unit (ICU) and to compare them with different physiologically based emergency scoring systems and the Manchester Triage System (MTS). Methods: In a prospective cohort-study, 1117 consecutive patients presenting to the medical ED were assessed. Data collected included age, sex, vital signs, temperature, oxygen saturation, respiratory rate, AVPU (Alert; Verbal response; response to Pain; Unresponsive)-score, MTS, different emergency scores and HbA1c. The data were correlated with LOS, hospital mortality and intensive care utilisation. Results: HbA1c had similar accuracy in predicting LOS as most physiologically based scores (AUC = 0.568, p = 0.688 to 0.714) and ICU utilisation (AUC = 0.525, p = 0.001 compared with MTS, for all others p = 0.077 to 0.830). HbA1c was positively correlated with LOS and ICU-transferral but correlated poorly with mortality, resulting in low predictive power (AUC = 0.501, p = 0.033 to 0.845). The subgroups with HbA1c below the median and below 6.5% had a shorter LOS (p = 0.012 and p = 0.004). The differences for other subgroups were not significant. Conclusions: HbA1c was positively correlated with LOS and ICU-referral, reflecting higher health-care utilisation, indicating that it may be a useful parameter in evaluating severity of illness in emergency patients.
Glycated haemoglobin, Emergency score, Manchester Triage System, Mortality, Length of stay, ICU referral
Markus Sander,Johannes Fickler,Uwe Neddermeyer,Stefan Von Delius,Stephan Budweiser. Predictive Value of HbA1c-levels with Regard to In-hospital Mortality, Length of Hospital Stay and Intensive Care Utilisation versus Different Emergency Risk Scores and the Manchester Triage System in Unselected Medical Emergency Admissions. Signa Vitae. 2020. 16(1);39-45.
 Brabrand M, Folkestad L, Groes Clausen N, Knudsen T, Hallas J. Risk scoring systems for adults admitted to the emergency department: a systematic review. Scand J Trauma Resus. 2010;18:8.
 McNarry AF, Goldhill DR. Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale. Anaesthsia. 2004;59(1):34–37.
 Manchester Triage Group. Mackway-Jones K, ed. Emergency triage. London: BMJ Publishing Group, 1997.
 Churpek MM, Yuen TC, Park SY, Meltzer DO, Hall B , Edelson DP. Derivation of a cardiac arrest prediction model using ward vital signs. Crit Care Med. 2012;40:2102–2108.
 Churpek MM, Yuen TC, Huber MT, Park SY, Hall JB, Edelson DP. Predicting cardiac arrest on the wards: a nested case-control study. Chest. 2012;141:1170-6.
 Recine U, Scotti E, Bruzzese V, D'Amore F, Manfelotto D, Simonelli I, et al. The Change of Hospital Internal Medicine: A Study on Patients admitted in Internal Medicine Wards of 8 Hospitals of the Lazio Area, Italy. Ital J Med. 2015;9:252-259.
 Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions . Q J Med. 2001;94:521-526.
 Duckitt RW, Buxton-Thomas R, Walker J, Cheek E, Bewick V, Venn R, et al. Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study. Br J Anaesth. 2007;98:769-74.
 Jones S, Mullally M, Ingleby S., Buist M, Bailey M, Eddleston J M. Bedside electronic capture of clinical observations and automated clinical alerts to improve compliance with an Early warning Score protocol. Crit Care Resus. 2011;13:83-88.
 Chen CL, Yen DH, Lin CS, Tsai SH, Chen SJ, Sheu WH, et al. Glycated hemoglobin level is an independent predictor of major adverse cardiac events after nonfatal acute myocardial infarction in nondiabetic patients. Medicine (Baltimore). 2017;96:e6743.
 Gornik I, Gornik O, Gasparovic V. HbA1c is outcome predictor in diabetic patients with sepsis. Diabetes ResClinPract.2007;77:120–125.
 Lorea E, Morhain H, García-Agulló O, de Esteban M, Beroiz I, Culleré G. Prognostic value of blood glucose in emergency room and glycosylated hemoglobin in patients who have suffered an acute cerebro-vascular event. Med Clin (Barc). 2017;S0025-7753:30032-5.
 Liu Y, Yang YM, Zhu J, Tan HQ, Liang Y, Li JD. Prognostic significance of hemoglobin A1c level in patients hospitalized with coronary artery disease. A systematic review and meta-analysis. Cardiovasc Diabetol. 2011;10: 98.
 Magee MF, Nassar C. Hemoglobin A1c Testing in an Emergency Department. J Diabetes Sci Technol. 2011;5: 1437–1443.
 Beagley J, Guariguata L, Weil L, Motala AA. Global estimates of undiagnosed diabetes in adults. Diabetes Res Clin Pract. 2014;103:150–160.
 Global report on diabetes. Geneva: World Health Organization; 2016.
 Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez JC et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics. 2011;12:77.
 DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–845.
 Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B. 1995;57:289–300.
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