Abstract
Background
We investigated independent mortality predictors of hyperglycemic crises and developed
a prediction rule for emergency and critical care physicians to classify patients
into mortality risk and disposition groups.
Methods
This study was done in a university-affiliated medical center. Consecutive adult patients
(> 18 years old) visiting the emergency department (ED) between January 2004 and December
2010 were enrolled when they met the criteria of a hyperglycemic crisis. Data were
separated into derivation and validation sets—the former were used to predict the
latter. December 31, 2008, was the cutoff date. Thirty-day mortality was the primary
endpoint.
Results
We enrolled 295 patients who made 330 visits to the ED: derivation set = 235 visits
(25 deaths: 10.6%), validation set = 95 visits (10 deaths: 10.5%). We found 6 independent
mortality predictors: Absent tachycardia, Hypotension, Anemia, Severe coma, Cancer history, and Infection (AHA.SCI). After assigning weights to each predictor, we developed a Predicting Hyperglycemic crisis Death (PHD) score that stratifies patients into mortality-risk and disposition groups:
low (0%) (95% CI, 0-0.02%): treatment in a general ward or the ED; intermediate (24.5%)
(95% CI, 14.8-39.9%): the intensive care unit or a general ward; and high (59.5%)
(95% CI, 42.2-74.8%): the intensive care unit. The area under the curve for the rule
was 0.946 in the derivation set and 0.925 in the validation set.
Conclusions
The PHD score is a simple and rapid rule for predicting 30-day mortality and classifying
mortality risk and disposition in adult patients with hyperglycemic crises.
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Article Info
Publication History
Published online: April 22, 2013
Accepted:
February 6,
2013
Received in revised form:
February 4,
2013
Received:
December 30,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
