Hyperglycaemia as a predictor of mortality and prolonged length of stay in severe sepsis and septic shock patients presented to red zone of emergency department, Hospital Universiti Sains Malaysia: a retrospective study

Abstract

Introduction: Initial or at-admission hyperglycaemia is a risk marker of morbidity and mortality in many acute critical illnesses. There has been no study to evaluate hyperglycaemia in severe sepsis and septic shock in the emergency department setting. Objectives: To investigate whether hyperglycaemia detected during patient initial presentation to emergency department has prognostic value in the outcome of severe sepsis and septic shock patients and compare it with other prognostic factors. Methods: A retrospective study in patients with severe sepsis and septic shock presented to the Red Zone of Emergency Department of Hospital University of Science Malaysia during 2008- 2011 was done. Data were collected by tracing patients medical records based on the attendance registry. Demographic data, initial capillary blood glucose and other factors which may predict the outcomes of severe sepsis and septic shock were collected and recorded. Results: Data were collected from 495 patients with severe sepsis and septic shock. The prevalence of stress hyperglycaemia was 14.9% and the overall initial hyperglycaemia was 40.2%. Initial hyperglycaemia did have significant prognostic value in determining mortality in non-diabetic patients (Chi-square 32.7% vs. 59.1%, p-value 0.001). No significant correlations were found between initial hyperglycaemia with prolonged hospital stay. However when multivariate analysis were done only high mMEDs score, lactate level and mechanical ventilator were associated with mortality and for prolonged length of stay only mMEDs score. Conclusion: Initial hyperglycaemia has prognostic value in determining mortality in non-diabetic but not in diabetic patients. No correlation can be made between initial hyperglycaemia and prolonged length of stay, as predicting length of stay is a complex nature and cannot be determined by single factor. When compared with other prognostic factors such as mMEDS score, lactate and ventilator use; hyperglycaemia was found to be inferior