Risk Factors for Adverse Outcomes in Adult and Pediatric Patients With Hyperglycemia Presenting to the Emergency Department: A Systematic Review

• Published in: Canadian journal of diabetes 2019-07, Vol.43 (5), p.361-369.e2
• Main Authors: Siddiqi, Lubna, BSc (Hon), VanAarsen, Kristine, MSc, Iansavichene, Alla, BSc, MLIS, Yan, Justin, BSc (Hon), MD, MSc, FRCPC
• Format: Article
• Language: English
• Subjects: Adult; adverse outcomes; diabetes mellitus; diabète sucré; emergency department; Emergency Service, Hospital - statistics & numerical data; Endocrinology and Metabolism; Hospitalization - statistics & numerical data; Humans; Hyperglycemia - etiology; Hyperglycemia - mortality; hyperglycemic emergencies; issues défavorables; Other; Prognosis; revue systématique; Risk Factors; service des urgences; Survival Rate; systematic review; urgences hyperglycémiques
• ISSN: 1499-2671; 2352-3840
• DOI: 10.1016/j.jcjd.2018.11.008

AbstractHyperglycemia is a significant cause of morbidity and mortality, often resulting in adverse outcomes. This review aimed to identify predictors of adverse outcomes, such as repeated hospital visits, hospitalization or death, in patients presenting to the emergency department (ED) with hyperglycemia. Electronic searches of Medline and EMBASE were conducted for studies in English of patients presenting to the ED with hyperglycemia. Both adult and pediatric populations were included, with and without diabetes. Two reviewers independently screened all titles and abstracts for relevance. If consensus was not reached, full-length manuscripts were reviewed. For discrepancies, a third reviewer was consulted. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Study- and patient-specific data were extracted and presented descriptively. Eight observational studies were reviewed; they included a total of 96,970 patients. Predictors of adverse outcomes included age, lowest income quintile, urban dwellers, presence of comorbidities, coexisting hyperlactatemia, having a family physician, elevated serum creatinine level, diabetes managed with insulin, sentinel visit for hyperglycemia in the past month, and high blood glucose level measured in the ED. Conflicting evidence was found for whether known history of diabetes was associated with risk. Factors associated with favourable outcomes included systolic blood pressure of 90 to 150 mmHg and tachycardia. This systematic review found 12 factors associated with adverse outcomes, and 2 factors associated with more favourable outcomes in patients presenting to the ED with hyperglycemia. These factors should be considered for easier identification of patients at higher risk for adverse outcomes to guide management and follow up.