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

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

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