PMID- 23167858
OWN - NLM
STAT- MEDLINE
DCOM- 20130429
LR  - 20211021
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Print)
IS  - 1069-6563 (Linking)
VI  - 19
IP  - 11
DP  - 2012 Nov
TI  - Hyperlactatemia affects the association of hyperglycemia with mortality in 
      nondiabetic adults with sepsis.
PG  - 1268-75
LID - 10.1111/acem.12015 [doi]
AB  - BACKGROUND: Admission hyperglycemia has been reported as a mortality risk factor 
      for septic nondiabetic patients; however, hyperglycemia's known association with 
      hyperlactatemia was not addressed in these analyses. OBJECTIVES: The objective 
      was to determine whether the association of hyperglycemia with mortality remains 
      significant when adjusted for concurrent hyperlactatemia. METHODS: This was a 
      post hoc, nested analysis of a retrospective cohort study performed at a single 
      center. Providers had identified study subjects during their emergency department 
      (ED) encounters; all data were collected from the electronic medical record 
      (EMR). Nondiabetic adult ED patients hospitalized for suspected infection, two or 
      more systemic inflammatory response syndrome (SIRS) criteria, and simultaneous 
      lactate and glucose testing in the ED were enrolled. The setting was the ED of an 
      urban teaching hospital from 2007 to 2009. To evaluate the association of 
      hyperglycemia (glucose > 200 mg/dL) with hyperlactatemia (lactate >/= 4.0 mmol/L), 
      a logistic regression model was created. The outcome was a diagnosis of 
      hyperlactatemia, and the primary variable of interest was hyperglycemia. A second 
      model was created to determine if coexisting hyperlactatemia affects 
      hyperglycemia's association with mortality; the main outcome was 28-day 
      mortality, and the primary risk variable was hyperglycemia with an interaction 
      term for simultaneous hyperlactatemia. Both models were adjusted for 
      demographics; comorbidities; presenting infectious source; and objective evidence 
      of renal, respiratory, hematologic, or cardiovascular dysfunction. RESULTS: A 
      total of 1,236 ED patients were included, and the median age was 77 years 
      (interquartile range [IQR] = 60 to 87 years). A total of 115 (9.3%) subjects were 
      hyperglycemic, 162 (13%) were hyperlactatemic, and 214 (17%) died within 28 days 
      of their initial ED visits. After adjustment, hyperglycemia was significantly 
      associated with simultaneous hyperlactatemia (odds ratio [OR] = 4.14, 95% 
      confidence interval [CI] = 2.65 to 6.45). Hyperglycemia and concurrent 
      hyperlactatemia were associated with increased mortality risk (OR = 3.96, 95% CI 
      = 2.01 to 7.79), but hyperglycemia in the absence of simultaneous hyperlactatemia 
      was not (OR = 0.78, 95% CI = 0.39 to 1.57). CONCLUSIONS: In this cohort of septic 
      adult nondiabetic patients, mortality risk did not increase with hyperglycemia 
      unless associated with simultaneous hyperlactatemia. The previously reported 
      association of hyperglycemia with mortality in nondiabetic sepsis may be due to 
      the association of hyperglycemia with hyperlactatemia.
CI  - (c) 2012 by the Society for Academic Emergency Medicine.
FAU - Green, Jeffrey P
AU  - Green JP
AD  - Department of Emergency Medicine, UC Davis Health System, UC Davis School of 
      Medicine, Sacramento, CA, USA. jeffrey.green@ucdmc.ucdavis.edu
FAU - Berger, Tony
AU  - Berger T
FAU - Garg, Nidhi
AU  - Garg N
FAU - Horeczko, Timothy
AU  - Horeczko T
FAU - Suarez, Alison
AU  - Suarez A
FAU - Radeos, Michael S
AU  - Radeos MS
FAU - Hagar, Yolanda
AU  - Hagar Y
FAU - Panacek, Edward A
AU  - Panacek EA
LA  - eng
GR  - UL1 TR000002/TR/NCATS NIH HHS/United States
GR  - 2UL 1RR024146/RR/NCRR NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
RN  - 0 (Lactates)
SB  - IM
MH  - Acidosis, Lactic/*epidemiology
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Case-Control Studies
MH  - Causality
MH  - Cause of Death
MH  - Comorbidity
MH  - Confidence Intervals
MH  - Diabetes Mellitus/epidemiology/physiopathology
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Female
MH  - Hospital Mortality/*trends
MH  - Hospitals, Teaching
MH  - Humans
MH  - Hyperglycemia/blood/*epidemiology
MH  - Lactates/*blood
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Reference Values
MH  - Retrospective Studies
MH  - Sepsis/blood/*epidemiology
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Urban Population
PMC - PMC3506124
MID - NIHMS413215
EDAT- 2012/11/22 06:00
MHDA- 2013/04/30 06:00
PMCR- 2013/11/01
CRDT- 2012/11/22 06:00
PHST- 2012/04/18 00:00 [received]
PHST- 2012/07/05 00:00 [revised]
PHST- 2012/07/06 00:00 [accepted]
PHST- 2012/11/22 06:00 [entrez]
PHST- 2012/11/22 06:00 [pubmed]
PHST- 2013/04/30 06:00 [medline]
PHST- 2013/11/01 00:00 [pmc-release]
AID - 10.1111/acem.12015 [doi]
PST - ppublish
SO  - Acad Emerg Med. 2012 Nov;19(11):1268-75. doi: 10.1111/acem.12015.