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.
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