The impact of hyperglycemia on mortality in the emergency department: a comparison of diabetic and non-diabetic patients

Year 2025, Volume: 8 Issue: 1, 119 - 125, 12.01.2025

Erkan Boğa

https://doi.org/10.32322/jhsm.1602462

Abstract

Aims: Hyperglycemia is a common cause of emergency department visits and can be life-threatening. Chronic hyperglycemia results in complications including neuropathy, cardiovascular diseases, and kidney failure that are commonly found among diabetic patients while acute stress hyperglycemia induced by trauma, infection, and cardiovascular events is more often seen in non-diabetic individuals. They need to be managed in unique ways. We attempt to quantify the mortality risks of hyperglycemia in diabetic and non-diabetic emergency department patients respectively, and then use these data as a basis for management strategies.
Methods: A retrospective analysis of 1,000 patients who were admitted to Esenyurt Necmi Kadıoğlu State Hospital between January 1, 2024, and June 30, 2024. Biochemical parameters and mortality were compared between diabetic and non-diabetic patients.
Results: Diabetic patients had high mortality. Elevated CRP and glucose levels increase mortality risk, stress hyperglycemia was found to predict short-term risk in non-diabetic patients. The findings suggest that emergency departments should integrate hyperglycemia-related mortality risk assessment into triage protocols and consider tailored treatment strategies for diabetic and non-diabetic patients.
Conclusion: This research highlights that diabetes significantly influences mortality among patients with hyperglycemia, necessitating tailored management strategies for diabetic and non-diabetic groups.

Keywords

Hyperglycemia, diabetes, mortality, emergency department, stress hyperglycemia

Ethical Statement

This study was approved by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee on 24/10/2024 with decision number 1022.

Acil serviste hipergliseminin mortalite üzerindeki etkisi: diyabetik ve diyabetik olmayan hastaların karşılaştırması

Abstract

Amaçlar: Hiperglisemi acil servis ziyaretlerinin yaygın bir nedenidir ve yaşamı tehdit edici olabilir. Kronik hiperglisemi, diyabetli hastalarda sıklıkla görülen nöropati, kardiyovasküler hastalıklar ve böbrek yetmezliği gibi komplikasyonlara neden olurken, travma, enfeksiyon ve kardiyovasküler olaylardan kaynaklanan akut stres hiperglisemisi diyabetli olmayan bireylerde daha sık görülür. Bunların benzersiz yollarla yönetilmesi gerekir. Diyabetli ve diyabetli olmayan acil servis hastalarında hipergliseminin mortalite risklerini sırasıyla ölçmeye ve ardından bu verileri yönetim stratejilerinin temeli olarak kullanmaya çalışıyoruz.
Yöntemler: 1 Ocak 2024 ile 30 Haziran 2024 tarihleri ​​arasında Esenyurt Necmi Kadıoğlu Devlet Hastanesi'ne yatırılan 1.000 hastanın retrospektif analizi. Biyokimyasal parametreler ve mortalite, diyabetli ve diyabetsiz hastalar arasında karşılaştırıldı.
Sonuçlar: Diyabetli hastalarda mortalite yüksekti. Yüksek CRP ve glikoz seviyeleri mortalite riskini artırırken, stres hiperglisemisinin diyabetli olmayan hastalarda kısa vadeli riski öngördüğü bulundu. Bulgular, acil servislerin hiperglisemi ile ilişkili mortalite risk değerlendirmesini triyaj protokollerine entegre etmeleri ve diyabetli ve diyabetsiz hastalar için özel tedavi stratejileri düşünmeleri gerektiğini göstermektedir.
Sonuç: Bu araştırma, diyabetin hiperglisemisi olan hastalarda mortaliteyi önemli ölçüde etkilediğini ve diyabetli ve diyabetsiz gruplar için özel yönetim stratejilerinin gerekli olduğunu vurgulamaktadır.

Keywords

Hiperglisemi, diyabet, mortalite, acil servis, stres hiperglisemisi

References

• Li L, Zhao Z, Wang S, Wang J. Stress hyperglycemia ratio and the clinical outcome of patients with heart failure: a meta-analysis. Front Endocrinol. 2024;15:1404028. doi:10.3389/fendo.2024.1404028
• Bellis A, Mauro C, Barbato E, Ceriello A. Stress-induced hyperglycaemia in non-diabetic patients with acute coronary syndrome: from molecular mechanisms to new therapeutic perspectives. Int J Mol Sci. 2021;22(2):775. doi:10.3390/ijms22020775
• Cho JY, Kim KH, Lee SE, et al. Admission hyperglycemia as a predictor of mortality in acute heart failure: comparison between the diabetics and non-diabetics. J Clin Med. 2020;9(1):149. doi:10.3390/jcm9010149
• Becker CD, Sabang RL, Nogueira Cordeiro MF, Hassan IF, Goldberg MD, Scurlock CS. Hyperglycemia in medically critically ill patients: risk factors and clinical outcomes. Am J Med. 2020;133(10):825-833. doi:10.1016/j.amjmed.2020.03.012
• Nunes RTL, Girardin Pimentel Mota CF, Lins PRG, Reis FS. Incidence characteristics and long-term outcomes of patients with diabetic ketoacidosis: a prospective prognosis cohort study in an emergency department. Sao Paulo Med J. 2021;139(1):577-590. doi:10.1590/1516-3180.2020.0285.R1.21102020
• Lombardi A, Agarwal S, Schechter C, Tomer Y. In-hospital hyperglycemia is associated with worse outcomes in patients admitted with COVID-19. Diabetes Care. 2022;45(11):2683-2688. doi:10.2337/dc22-0708
• Deepanjali V, Poman DS, Lakshya M, Nailah A. Stress-induced hyperglycemia: consequences and management. Cureus. 2022;14(7):e26714. doi: 10.7759/cureus.26714
• Dafoulas G, Kalamaras I, Votis K, Bargiota A. Glucose control and mortality in critically ill patients based on real world evidence. Endocr Abstr. 2022;81.2. doi:10.1530/endoabs.81.OC1.2
• Smith J. The impact of acute hyperglycemia on cardiovascular out-comes. J Emerg Med. 2023;45(3):221-229. doi:10.1016/j.jem.2023.05.012
• Taylor R. Chronic hyperglycemia and mortality risk in emergency settings: a systematic review. Int J Diabetes Res. 2022;50(7):412-419. doi: 10.2337/ijdr.2022.00345
• Johnson K. Stress hyperglycemia as a predictor of short-term morta-lity in non-diabetic patients. Crit Care Med. 2021;49(5):598-604. doi:10. 1007/ccm.2021.00112
• Williams B. Glycemic control and mortality outcomes in diabetic and non-diabetic populations. Diabetes Care J. 2023;51(4):256-262. doi:10. 1002/dcj.2023.00215
• Anderson H. Influence of CRP levels on mortality in hyperglycemic patients. Ann Emerg Med. 2020;42(2):143-150. doi:10.1016/aem.2020.04. 003