Elevated admission glucose and mortality in patients with acute pulmonary embolism

Hyperglycemia and Venous Thromboembolism

Patients with diabetes mellitus (DM) have chronically increased blood glucose and multiple physiologic alterations that place them at elevated risk for vascular disease. Traditionally, this vascular risk has mainly referred to chronic atherosclerosis and embolic arterial disease. Retrospective studies have suggested an increased risk of a pulmonary embolism (PE) and deep vein thrombosis (DVT), collectively termed venous thromboembolism (VTE), in patients with DM, but this association has been difficult to demonstrate with comorbidities such as obesity in meta-analysis. Clinical studies have demonstrated worse outcomes for patients with DM who suffer from VTE. In vitro studies show multiple physiologic abnormalities with chronic inflammation, endothelial dysfunction, dysfunction in the coagulation cascade, as well as other changes that drive a vicious cycle of hypercoagulability. Aggressive medical management of DM can improve vascular outcomes, and some anti-hyperglycemic therapies may modify VTE risk as well. Anticoagulation strategies are similar for patients with DM, but with some added considerations, such as high rates of comorbid renal dysfunction. More research is needed to definitively categorize DM as a risk factor for VTE and elucidate specific therapeutic strategies.

Association between diabetes and venous thromboembolism: A systematic review and meta-analysis

BACKGROUND

Diabetes mellitus (DM) plays a vital role in the development of cardiovascular disease. However, its association with venous thromboembolism (VTE) remains unclear, for the published study results are conflicting. We performed a meta-analysis of published cohort studies and case-control studies to assess the role of DM in the formation and prognosis of VTE.

METHODS

PubMed and EMBASE databases were searched for articles from the database's establishment until September 15, 2022. Of the 15,754 publications retrieved, 50 studies were identified that met the selection criteria. The New castle-Ottawa Scale was used to evaluate the quality of the literature. Pooled odds ratios (ORs) and 95% confidence intervals were calculated using fixed- or random-effect models.

RESULTS

We combined OR using a random-effects or fixed-effects model: patients with DM had an increased risk of VTE (OR 1.27, 95% confidence interval [CI]: 1.15-1.41), which still showed a partial association in studies adjusted by confounding factors (OR 1.20, 95% CI: 1.07-1.35). DM was not significantly associated with VTE when analyzed in studies adjusted by body mass index (OR 1.04, 95% CI: 0.94-1.15). VTE patients with DM had a higher risk of short-term and long-term mortality than those without DM (OR 1.58 [95% CI: 1.26-1.99] for long-term mortality and OR 1.20 [95% CI: 1.19-1.21] for short-term mortality).

CONCLUSION

There was no significant association between DM and VTE risk, and body mass index may be a significant confounding factor between DM and VTE risk. However, DM can still lead to an increased risk of long-term and short-term mortality in patients with VTE.

Admission glucose as a prognostic marker for all-cause mortality and cardiovascular disease

BACKGROUND

Diabetes and prediabetes are known risk factors for cardiovascular disease and associated with increased mortality risk. Whether patients with a random elevated blood glucose level but no history of diabetes are at a higher mortality and cardiovascular risk is not entirely known.

METHODS

A retrospective cohort study where patients (18-80 years) with no history of diabetes between 2006 and 2016 attending the emergency department (ED) in Sweden were included. Based on the first (index) blood glucose level patients were categorized into four groups: hypoglycemia (< 3.9 mmol/L), normal glucose tolerance (NGT) (3.9-7.8 mmol/L), dysglycemia (7.8-11.1 mmol/L), and hyperglycemia (> 11.1 mmol/L). Data was collected from four nationwide registers (National Patient Register, National Cause of Death Register, Prescribed Drug Register and Statistics Sweden). Cox regression was used to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI) for all-cause mortality and cardiovascular outcomes using NGT as reference.

RESULTS

618,694 patients were included during a mean follow-up time of 3.9 years. According to the index blood glucose level: 1871 (0.3%) had hypoglycemia, 525,636 (85%) had NGT, 77,442 (13%) had dysglycemia, and 13,745 (2%) patients had hyperglycemia, respectively. During follow-up 44,532 (7.2%) deaths occurred. After multiple adjustments, mortality risk was highest in patients with hypoglycemia HR 2.58 (2.26-2.96) followed by patients with hyperglycemia HR 1.69 (1.63-1.76) and dysglycemia HR 1.16 (1.13-1.19). Risk for cardiovascular events: i.e., myocardial infarction, stroke and heart failure, were highest among patients with hyperglycemia HR 2.28 (2.13-2.44), HR 1.62 (1.51-1.74) and HR 1.60 (1.46-1.75), respectively.

CONCLUSION

Patients with disturbed blood glucose level at ED admission have a higher mortality risk than patients with NGT. Patients with hyperglycemia have almost a two folded increased long-term mortality risk and more than a doubled risk for cardiovascular events compared to patients with NGT.

Diabetes mellitus and its impact on mortality rate and outcome in pulmonary embolism

AIMS/INTRODUCTION

In patients with pulmonary embolism (PE), the impact of diabetes mellitus on patient profile and outcome is not well investigated.

MATERIAL AND METHODS

The German nationwide inpatient sample of the years 2005-2018 was analyzed. Hospitalized PE patients were stratified for diabetes, and the impact of diabetes on in-hospital events was investigated.

RESULTS

Overall, 1,174,196 PE patients (53.8% aged ≥70 years, 53.5% women) and, among these, 219,550 (18.7%) diabetes patients were included. In-hospital mortality rate amounted to 15.8%, and was higher in diabetes patients than in non-diabetes patients (19.8% vs 14.8%, P < 0.001). PE patients with diabetes had a higher prevalence of cardiovascular risk factors, comorbidities, right ventricular dysfunction (31.8% vs 27.7%, P < 0.001), prolonged in-hospital stay (11.0 vs 9.0 days, P < 0.001) and higher rates of adverse in-hospital events. Remarkably, diabetes was independently associated with increased in-hospital mortality (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.20-1.23, P < 0.001) when adjusted for age, sex and comorbidities. Within the observation period of 2005-2018, a relevant decrease of in-hospital mortality in PE patients with diabetes was observed (25.5% to 16.8%). Systemic thrombolysis was more often administered to diabetes patients (OR 1.18, 95% CI 1.01-3.49, P < 0.001), and diabetes was associated with intracerebral (OR 1.19, 95% CI 1.12-1.26, P < 0.001), as well as gastrointestinal bleeding (OR 1.11, 95% CI 1.07-1.15, P < 0.001). Type 1 diabetes mellitus was shown to be a strong risk factor in PE patients for shock, right ventricular dysfunction, cardiopulmonary resuscitation and in-hospital death (OR 1.75, 95% CI 1.61-1.90, P < 0.001).

CONCLUSIONS

Despite the progress in diabetes treatments, diabetes is still associated with an unfavorable clinical patient profile and higher risk for adverse events, including substantially increased in-hospital mortality in acute PE.

Discovery of plasma biomarkers with data-independent acquisition mass spectrometry and antibody microarray for diagnosis and risk stratification of pulmonary embolism

BACKGROUND

Pulmonary embolism (PE) is a leading cause of cardiovascular mortality worldwide. Rapid and accurate diagnosis and risk stratification are crucial for timely treatment options, especially in high-risk PE.

OBJECTIVES

The study aims to profile the comprehensive changes of plasma proteomes in PE patients and identify the potential biomarkers for both diagnosis and risk stratification.

PATIENTS/METHODS

Based on the data-independent acquisition mass spectrometry and antibody array proteomic technology, we screened the plasma samples (13 and 32 proteomes, respectively) in two independent studies consisting of high-risk PE patients, non-high-risk PE patients, and healthy controls. Some significantly differentially expressed proteins were quantified by ELISA in a new study group with 50 PE patients and 26 healthy controls.

RESULTS

We identified 207 and 70 differentially expressed proteins in PE and high-risk PE. These proteins were involved in multiple thrombosis-associated biological processes including blood coagulation, inflammation, injury, repair, and chemokine-mediated cellular response. It was verified that five proteins including SAA1, S100A8, TNC, GSN, and HRG had significant change in PE and/or in high-risk PE. The receiver operating characteristic curve analysis based on binary logistic regression showed that the area under the curve (AUC) of SAA1, S100A8, and TNC in PE diagnosis were 0.882, 0.788, and 0.795, and AUC of S100A8 and TNC in high-risk PE diagnosis were 0.773 and 0.720.

CONCLUSION

As predictors of inflammation or injury repair, SAA1, S100A8, and TNC are potential plasma biomarkers for the diagnosis and risk stratification of PE.

Stress Hyperglycaemia Indicates Embolus Size and Localization in Patients with Acute Pulmonary Embolism

OBJECTIVE

Acute pulmonary embolism is a life-threatening form of venous thromboembolism often causing stress hyperglycaemia. The aim of this study was to determine the prognostic value of stress hyperglycaemia in acute pulmonary embolism, providing new insights into the presumed embolus size and localization, clinical parameters (Pulmonary Embolism Severity Index, PESI), and in-hospital mortality. Design and Methods. Among a total of 95,454 patients referred to the Emergency Department of the Sestre Milosrdnice University Hospital Centre between 2014 and 2016, all patients with acute pulmonary embolism were included into this observational cohort study. The study group consisted of 190 patients aged 25-96. Relevant patient history, clinical data, and laboratory findings were collected during the entire hospitalization period. Data were analyzed for the entire group of patients, as well as separately for patients without diabetes, using the Fisher exact test and logistic regression.

RESULTS

Analysis of embolus localization as an indirect parameter of embolus size showed that patients with stress hyperglycaemia more often had emboli located in proximal parts of the pulmonary circulation (i.e., main artery or lobar branches) (p < 0.05). Furthermore, stress hyperglycaemia correlated with PESI score and diabetes (p < 0.05) in the entire patient group. Stress hyperglycaemia showed independent association with in-hospital mortality in patients (p < 0.05).

CONCLUSION

Stress hyperglycaemia in patients with acute pulmonary embolism is associated with embolus localization in larger arteries of the pulmonary circulation and higher PESI score and therefore could serve as an independent in-hospital mortality predictor.

The predictive value of plasma osmolality for in-hospital mortality in patients with acute pulmonary embolism

INTRODUCTION AND OBJECTIVES

Prior studies demonstrated that plasma osmolality may have a predictive value for in-hospital mortality in patients with heart failure and acute coronary syndrome. In addition, plasma glucose and blood urea nitrogen (BUN) levels, the components of plasma osmolality, have been shown to be an important contributor for in-hospital mortality in acute pulmonary embolism (APE) patients. Hence, the objective of the current study is to evaluate the effect of plasma osmolality upon admission with in-hospital mortality in patients with APE.

METHODS

A total of 245 consecutive intermediate or high risk APE patients were enrolled into the study. The study population was divided into three tertile groups (T1, T2 and T3) based on the increased plasma osmolality. The in-hospital mortality was the primary end-point.

RESULTS

After adjusting for all risk factors, in-hospital mortality was significantly higher in the T3 group compared to T1 and T2 groups (OR: 3.6, 95% CI: 1.3 to 18.8, P < .001). In addition, the incidence of asystolia, hypotension and cardiogenic shock were significantly higher in the T3 group. An area under the receiver operating characteristic curve value of plasma osmolality for the in-hospital mortality was 0.76 with sensitivity 67.2% and specificity 74.1% 95% CI: (0.66-0.87, P < .001).

CONCLUSION

This is the first study to demonstrate that elevated levels of plasma osmolality may have a predictive value for in-hospital mortality in APE patients. Our findings are novel and deserve further studies whether the treatment of higher plasma osmolality may reduce the risk of in-hospital mortality in APE patients.

Prognostic value of blood biomarkers in patients with unprovoked acute pulmonary embolism

BACKGROUND:

Better outcomes have been observed in patients with acute unprovoked than provoked pulmonary embolism (PE). Prognostic biomarkers were studied in heterogeneous patient population and were not verified in patients with unprovoked PE.

METHODS:

Patients diagnosed with unprovoked acute PE from 2010 to 2017 at Asan Medical Center, South Korea, were analyzed retrospectively. Adverse composite outcomes were defined as thrombolysis, thrombectomy, extracorporeal membrane oxygenation, or death. Venous blood samples were collected at the first visit before anticoagulant treatment. Biomarkers associated with composite outcomes were analyzed and compared with preexisting risk models.

RESULTS:

This study included 265 patients (48.7% male) with a median age of 66.0 (interquartile range 52.0, 75.0) years. Composite outcomes occurred in 20 (7.5%) patients. Hemoglobin, uric acid, and glucose were significantly and independently associated with adverse composite outcomes. This biomarker model showed the highest prognostic accuracy for adverse composite outcomes, with an area under the curve of 0.806 (95% confidence interval: 0.702–0.911, P < 0.001), which was significantly better than that of PE severity index (PESI) or simplified PESI, and comparable to that of the European Society of Cardiology (ESC) risk classification.

CONCLUSIONS:

The biomarker model including hemoglobin, uric acid, and glucose has good prognostic performance comparable to the ESC risk classification while PESI or simplified PESI score was not useful in unprovoked PE.

Mortality after pulmonary embolism in patients with diabetes. Findings from the RIETE registry

BACKGROUND

Among patients presenting with pulmonary embolism (PE), those with diabetes are at increased risk to die than those without diabetes. The reasons have not been identified. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to compare the mortality rate and the causes of death during anticoagulation in patients with PE according to the presence or absence of diabetes.

METHODS

A matched retrospective cohort study from consecutively enrolled patients in RIETE, from 179 hospitals in 24 countries. For each patient with diabetes we selected two patients with no diabetes matched by age, sex and year of diagnosis of the PE.

RESULTS

As of September 2017, there were 2010 PE patients with diabetes and two age-and-gender matched controls. Mean age was 74 ± 11 years, 46% were men. Patients with diabetes were more likely to have co-morbidities, to be using antiplatelets and to have more severe PE. During anticoagulation (median, 219 days), patients with diabetes had a higher mortality (hazard ratio [HR]: 1.45; 95% confidence intervals [CI]: 1.25-1.67) and a higher rate of arterial ischemic events (HR: 2.89; 95%CI: 1.71-4.94) than those without diabetes. On multivariable analysis, diabetes was not associated with an increased risk for death (HR: 1.26; 95%CI: 0.97-1.63). We also failed to find differences according to the use of antiplatelet drugs concomitantly.

CONCLUSIONS

In our cohort of patients with PE, diabetes was not an independent predictor for death. The influence of arterial events or antiplatelet drugs (if any) was low.

Association of Admission Glucose Level and Improvement in Pulmonary Artery Pressure in Patients with Submassive-type Acute Pulmonary Embolism

Objective The admission glucose level is a predictor of mortality even in patients with acute pulmonary embolism (APE). However, whether or not the admission glucose level is associated with the severity of APE itself or the underlying disease of APE is unclear. Methods This study was a retrospective observational study. A pulmonary artery (PA) catheter was used to accurately evaluate the severity of APE. The percentage changes in the mean PA pressure (PAPm) upon placement and removal of the inferior vena cava filter (IVCF) were evaluated. We hypothesized that the admission glucose level was associated with the improvement in the PA pressure in patients with APE. Patients A total of consecutive 22 patients with submassive APE who underwent temporary or retrievable IVCF insertion on admission and repetitive PA catheter measurements upon placement and removal of IVCFs were enrolled. Results There was a significant positive correlation between the admission glucose levels and the percentage changes in the PAPm (r=0.543, p=0.009). A univariate linear regression analysis showed that the admission glucose level was the predictor of the percentage change in PAPm (β coefficient=0.169 per 1 mg/dL; 95% confidence interval, 0.047-0.291; p=0.009). A multivariate linear regression analysis with the forced inclusion model showed that the admission glucose level was the predictor of the percentage change in PAPm independent of diabetes mellitus, PAPm on admission, troponin positivity, and brain natriuretic peptide level (all p<0.05). Conclusion The admission glucose level was associated with the improvement in the PAPm in patients with submassive-type APE.

The Predictive Value of Glycated Hemoglobin and Albumin for the Clinical Course Following Hospitalization of Patients with Febrile Urinary Tract Infection

Background

Diabetes is considered a risk factor for acquisition of febrile urinary tract infection (f-UTI), but information on the association of diabetes with subsequent course of the disease is lacking. Thus, we investigated the clinical variables including diabetic status which determined the clinical course in patients with community-acquired f-UTI.

Materials and Methods

Patients hospitalized consecutively for f-UTI between February 2016 and January 2018 were used for this single center study. The routine laboratory tests including blood glucose and glycated hemoglobin (HbA1c) were done and empiric treatment with parenteral antibiotics was commenced on admission. The clinical course such as duration of fever (DOF) and length of hospital stay (LOS) were compared among groups classified by the clinical variables.

Results

Among the101 patients admitted for f-UTI, 15 patients with diabetes (14.9%) experienced significantly longer febrile period and hospitalization compared to those with hyperglycemia (n = 18, 17.8%) or those without diabetes and hyperglycemia (n = 68, 67.3%). Of the laboratory parameters tested on admission and several clinical factors, the presence of diabetes and risk factors for severe complicated infection (hydronephrosis, urosepsis, and disseminated intravascular coagulopathy) as well as HbA1c and albumin were identified as predictors for LOS by univariate analysis, whereas none of the variables failed to predict DOF. In the subsequent multivariate analysis, HbA1c levels and albumin levels were isolated as independent predictors of LOS.

Conclusion

Patients with higher HbA1c and lower albumin levels required the longest period of hospitalization. Thus, an evaluation of diabetic and nutritional status on admission will be feasible to foretell the clinical course and better manage the subset of patients at risk of prolonged hospitalization.

Hyperglycemia on admission and hospitalization outcomes in patients with atrial fibrillation

BACKGROUND

We evaluated the association of admission blood glucose (ABG) and mortality in patients with and without diabetes mellitus (DM) hospitalized for atrial fibrillation (AF).

HYPOTHESIS

Hyperglycemia on admission is a bad prognostic marker in patients with AF.

METHODS

Observational data were collected from electronic records of patients age ≥ 18 years hospitalized for AF in 2011-2013. Twelve-month data were available in all cases. ABG levels were classified as follows: 70 to 110 mg/dL, normal; 111 to 140 mg/dL, mildly elevated; 141 to 199 mg/dL, moderately elevated; ≥200 mg/dL, markedly elevated. Cox proportional hazards model was used to assess overall survival by ABG categories, adjusted for study variables. Primary outcome measure was mortality at end of follow-up.

RESULTS

The cohort included 1127 patients (45% male; median age, 75 ± 13 years), of whom 331 had DM. Mortality rates by ABG levels were 19% (77/407 patients), normal ABG; 26% (92/353 patients), mildly elevated ABG; 28% (69/244 patients), moderately elevated ABG; and 41% (50/123 patients), markedly elevated ABG. Data were analyzed for the entire cohort following adjustment for age, sex, CHADS₂ score, ischemic heart disease, smoking, and alcohol consumption. Compared with normal ABG, the adjusted hazard ratio for mortality was higher in patients with moderately elevated ABG (2.1, 95% confidence interval: 1.19-7.94, P < 0.05) and markedly elevated ABG (1.6, 95% confidence interval: 1.02-5.31, P < 0.05).

CONCLUSIONS

In patients with and without DM hospitalized for AF, moderately to markedly elevated ABG levels are associated with increased mortality.

Blood glucose on admission and mortality in patients with venous thromboembolism

AIMS

Evaluate association between admission blood glucose (ABG) and mortality in patients with or without diabetes mellitus (DM) hospitalized for venous thromboembolism (VTE).

METHODS

Observational data derived from the electronic records of hospitalized patients ≥18years, admitted for VTE (including deep vein thrombosis and pulmonary embolism) between January 2011 and December 2013. ABG levels were classified to categories: ≤70 (low), 70-110 (normal), 111-140 (mildly elevated), 141-180mg/dl (moderately elevated) and>180mg/dl (markedly elevated). Main outcome was all-cause mortality at the end of follow-up. We had complete follow-up data at 12months for all patients; median follow-up time was 1126days.

RESULTS

Cohort included 567 patients, 137 with (mean age 73, 45% male), and 430 without DM (mean age 65, 40% male). There was a significant interaction between DM, ABG and mortality (p≤0.05). In patients without DM there was a significant association between ABG and mortality: [hazard ratios 1.6, 2.3, and 4.7 respectively for mildly, moderately and markedly elevated ABG (p≤0.01)]. A significant association between ABG and mortality persisted following multivariable analysis only in patients with markedly elevated ABG (HR=2.3 95% CI 1.2-4.5). Similar results were evident in patients with deep vein thrombosis or pulmonary embolism. In patients with DM there was no significant association between ABG and mortality.

CONCLUSION

In patients without DM hospitalized for VTE, markedly elevated ABG is associated with increased mortality.

Does intermittent pneumatic compression increase the risk of pulmonary embolism in deep venous thrombosis after joint surgery?

The present study aimed to identify the incidence and risk factors of symptomatic pulmonary embolism and evaluate the safety of early intermittent pneumatic compression application in patients with deep venous thrombosis (DVT) after joint surgery. A total of 144 patients with DVT undergoing joint surgery were divided into two groups according to the appearance of symptomatic pulmonary embolism. Venography and computed tomographic pulmonary angiography were utilized as the assessment methods. The total incidence of symptomatic pulmonary embolism was 0.39% after joint surgery. However, the prevalence increased to 3.5% when computed in patients with DVT. Patients with symptomatic pulmonary embolism were older than those without symptomatic pulmonary embolism (69 ± 4 versus 61 ± 15 years, P = 0.04). The occurrence rate of symptomatic pulmonary embolism in patients with diabetes mellitus was much higher than that in the patients without diabetes mellitus (40.0% versus 8.6%, respectively, P = 0.02). The prevalence of symptomatic pulmonary embolism after joint surgery in patients with DVT was not distinctive. Increased age and diabetes mellitus put patients with DVT at risk of suffering symptomatic pulmonary embolism after joint surgery. In addition, early postoperative application of intermittent pneumatic compression was safe in these patients.

The accuracy of combined use of troponin and red cell distribution width in predicting mortality of patients with acute pulmonary embolism

BACKGROUND

Cardiac troponins and red cell distribution width (RDW) are associated with increased mortality in acute pulmonary embolism (PE). In this study, we aimed to investigate the accuracy of the combined use of troponin and RDW in predicting short-term mortality in acute PE patients.

METHODS

The data of 201 patients with the diagnosis of acute PE were retrospectively analyzed. We obtained troponin-RDW scores (TR scores) using a combination of troponin and RDW values, and then evaluated this score's accuracy in predicting mortality in patients with acute PE.

RESULTS

The mean participant age was 68 ± 16 years, and 52 % of patients were female. Fifteen (7.4 %) patients died during the first month. Patients classified as high-risk according to TR scores were older (72 ± 15 vs. 66 ± 15 years, p = 0.005), and they had higher heart rates (101 ± 20 vs. 90 ± 15 beat/min, p < 0.001) and respiratory rates (23 ± 4 vs. 21 ± 3 breath/min, p = 0.001). In multivariate analysis, TR (odds ratio [OR] 4.93, 95 % confidence interval [CI] 1.13-21.38, p = 0.033) and simplified pulmonary embolism severity index (sPESI) scores (OR 3.78, 95 % CI 1.71-8.37, p = 0.002) were independent predictors of 30-day mortality. For 30-day mortality, the TR score had a slightly lower sensitivity (87 % vs. 93 %), but a higher specificity (69 % vs. 52 %) compared to the sPESI score.

CONCLUSION

The TR score is easy to calculate, and it may be used to predict early mortality in patients with acute PE.

Admission blood glucose predicts mortality and length of stay in patients admitted through the emergency department

BACKGROUND

Hyperglycaemia has been associated with adverse outcomes in several different hospital populations.

AIM

The aim of this study was to investigate the relationship between admission blood glucose level (BGL) and outcomes in all patients admitted through the emergency department.

METHODS

This study was a retrospective observational cohort study from an Australian tertiary referral hospital. Patients admitted in the first week of each month from April to October 2012 had demographic data, co-morbidities, BGL, intensive care unit admission, length of stay and dates of death recorded. Factors associated with outcomes were assessed by multi-level mixed-effects linear regression.

RESULTS

Admission BGL was recorded for 601 admissions with no diagnosis of diabetes and for 219 admissions diagnosed with type 2 diabetes (T2DM). In patients with no diagnosis of diabetes, admission BGL was associated with in-hospital and 90-day mortality (P < 0.001). After multivariate analysis, BGL greater than 11.5 mmol/L was significantly associated with increased mortality at 90 days (P < 0.05). In patients with T2DM increased BGL on admission was not associated with in-hospital or 90-day mortality but was associated with length of hospital stay (β: 0.22 days/mmol/L; 95% confidence interval 0.09-0.35; P < 0.001), although this association was lost on multivariable analysis. In patients with T2DM, increased coefficient of variation of BGL was also positively associated with length of hospital stay in an almost dose-dependent fashion (P < 0.001).

CONCLUSION

Admission BGL was independently associated with increased mortality in patients with no diagnosis of diabetes. Glycaemic variability was associated with increased length of hospital stay in patients with T2DM.

The prognostic significance of admission blood glucose levels in elderly patients with pneumonia (GAP Study)

AIMS

Evaluate the association between admission blood glucose (ABG) and short and long-term mortality following hospitalization for pneumonia of elderly patients with and without diabetes mellitus (DM).

METHODS

Observational data derived from the electronic records of hospitalized patients ≥65years, admitted for pneumonia between January 2011 and December 2013. ABG levels were classified to categories: ≤70 (low), 70-110 (normal), 111-140 (mildly elevated), 141-199mg/dl (moderately elevated) and ≥200mg/dl (markedly elevated). Main outcomes were all-cause mortality rates at various time points.

RESULTS

Cohort included 2164 patients, 743 with DM (mean age 81, 53% male) and 1421 without it (mean age 83, 52% male). There was a significant interaction between DM, ABG and mortality (p≤0.05). In patients without DM, compared with normal ABG, in-hospital and 30-day mortality rates (adjusted hazard ratio, 95% CI) were higher with moderately (1.5 and 1.4, respectively, p<0.05) and markedly elevated ABG (2.7 and 1.9, respectively, p<0.05). Long-term results were similar at 12 and 36months (1.3 and 1.8, respectively, p<0.05, for moderately and markedly elevated ABG).

CONCLUSION

In elderly non-diabetic patients hospitalized for pneumonia, moderately and markedly elevated ABG is associated with increased short- and long-term mortality. In diabetic patients there is no association between ABG and mortality.

The prognostic significance of admission blood glucose levels in patients with urinary tract infection

AIMS

Evaluate the association between admission blood glucose (ABG) and short and long-term outcomes following hospitalization for urinary tract infection (UTI).

METHODS

Single center, retrospective cohort study of patients admitted to medical wards between January 1, 2011 and December 31, 2013 with a diagnosis of UTI. Patients were classified to those with diabetes mellitus (DM) and those without it. ABG levels were classified to categories: ≤70, 70-110, 111-199, ≥200mg/dl. Primary outcome was all-cause mortality within 30-days and 1-year. Secondary outcomes were hospital readmissions within 30-days and 1-year, and survival rates at end of follow-up.

RESULTS

Cohort included 3405 patients (median age, 78 years; 44% men), 1106 with DM and 2299 without it. Among patients without DM, compared with ABG between 70 and 110mg/dl (n=852, 37%), there was a significant association between ABG and all-cause mortality: hazard ratios (95% CI) with ABG ≤70mg/dl (n=13, 0.6%), 111-199mg/dl (n=1292, 56%), and ≥200mg/dl (n=142, 6%) were: 3.67 (0.89-15.14, p=0.07, 23% mortality (n=3)), 1.85 (1.29-2.64, p<0.001, 7% mortality (n=89)), and 2.94 (1.71-5.07, p<0.0001, 11% mortality (n=15)) at 30-days, and 3.8 (1.87-7.71, 38% mortality (n=5)), 1.35 (1 1.13-1.60, 7% mortality (n=215)), and 2.02 (1.50-2.71, 25% mortality (n=35)) at 1-year (all p<0.001). In patients with DM there was no significant association between ABG and mortality. There was no association between ABG and readmissions in both groups.

CONCLUSION

There is a significant association between ABG and short and long-term, all-cause mortality in patients without DM, but not in patients with DM, hospitalized for UTI.

Admission Glucose Level Predicts In-hospital Mortality in Patients with Acute Pulmonary Embolism Who Were Treated with Thrombolytic Therapy

BACKGROUND

Elevated admission serum glucose level is associated with unfavourable clinical outcomes in various clinical conditions. The aim of this study was to investigate the relationship between admission glucose levels and in-hospital and long-term adverse clinical outcomes in patients with pulmonary embolism (PE) treated with thrombolytic therapy.

METHODS

A total of 183 consecutive confirmed acute PE patients (98 female and 85 male; mean age 61.9 ± 15.7 years) who were treated with thrombolytic therapy enrolled in this study. The study population was categorised into four quartiles according to admission serum glucose levels (group I: glucose ≤115 mg/dl; group II: glucose >115-141 mg/dl; group III: glucose >141-195 mg/dl; and group IV: glucose ≥196 mg/dl).

RESULTS

In-hospital mortality was significantly higher in group IV (28.8 %) compared to group III (15.2 %), group II (6.6 %), and group I (2.1 %) (p < 0.001). In multivariate analysis, admission glucose level (OR 1.013, 95 % CI 1.004-1.021, p = 0.004) and admission anaemia (OR 0.602, 95 % CI 0.380-0.955, p = 0.03) were independent predictors of in-hospital mortality. The mean follow-up period was 34 months. During long-term follow-up, all-cause mortality, recurrent PE, major and minor bleeding were similar among the four groups.

CONCLUSION

Admission glucose level is a simple, inexpensive, easily available, and effective laboratory parameter for predicting in-hospital mortality in patients with PE.

Predictive value of biomarkers for the prognosis of acute pulmonary embolism in Japanese patients: Results of the Tokyo CCU Network registry

BACKGROUND

Several studies from Western countries have reported associations between cardiac troponin and B-type natriuretic peptide (BNP) levels and acute pulmonary embolism prognosis; however, the number of such reports from Asian countries, including Japan, is limited. Thus, we evaluated the relationship between blood biochemical findings and acute-phase pulmonary embolism prognosis in Japanese patients.

METHODS

The subjects included 441 patients with acute pulmonary embolism (191 men, 250 women; average age, 65.8±16.0 years) treated at Tokyo CCU Network Institutions from 2009 to 2011 and registered via survey forms. The association between blood biochemical findings at admission and 30-day mortality was investigated.

RESULTS

The median BNP value was 186.5pg/mL (25th to 75th interquartile range: 49.8-500pg/mL) of 210 cases. No deaths were recorded among those with BNP levels <90pg/mL (n=70), whereas significantly higher mortality (10 deaths/140 cases, 7.1%; p=0.033) was observed among those with BNP levels ≥90pg/mL. A qualitative cardiac troponin test was positive in 58 of the 204 cases (28.4%), with a significantly higher mortality incidence (p=0.017) among the troponin-positive cases [6 (10.3%) versus 3 (2.1%) deaths among the 146 troponin-negative cases]. The overall mean blood glucose level at admission of 331 cases was 152.0±74.0mg/dL, and 30-day mortality significantly increased with blood glucose values (p=0.048).

CONCLUSIONS

Troponin, BNP, and blood glucose levels are useful prognostic biomarkers for acute pulmonary embolism in Japanese patients.

Current status of the use of inferior vena cava filters in cases of pulmonary embolism in CCUs: From the Tokyo CCU Network

OBJECTIVE

To elucidate the current status of use of inferior vena cava filters (IVCFs) in cases of pulmonary embolism at institutions belonging to the Tokyo CCU Network.

METHODS

We conducted a retrospective investigation of 832 consecutive cases of pulmonary embolism reported on survey forms to the Tokyo CCU Network between 2005 and 2010.

RESULTS

Of 832 cases of pulmonary embolism, IVCFs were used in 338 (40.6%) and not used in 415 (49.9%). Their use was unclear in 79 (9.5%) cases. The use rate gradually increased each year from 2005 until 2008 but decreased from 2009 onward. Moreover, 68.9% of the IVCFs used in cases were non-permanent types. In terms of pulmonary embolism severity, the rate of use was 37.2% in non-massive cases, 49.4% in sub-massive cases, 46.9% in massive cases, and 31.9% in collapse cases. Thirty-day mortality in cases of collapse in which IVCFs were not used was extremely high at 75.8%, suggesting that in many cases, rapid deterioration may occur with insufficient time for IVCF insertion. The differences in IVCF usage rate among institutions were large in the range of 12.5-90% from 2005 to 2008, which slightly declined to the range of 25.0-72.2% from 2009 to 2010.

CONCLUSIONS

We elucidated the current IVCF use status in cases of pulmonary embolism at institutions belonging to the Tokyo CCU Network. Since the status of use differed among institutions, future studies of effective methods of use are required.