Southern California Conferences for Undergraduate Research

Southern California Conferences for Undergraduate Research

Assessment of Concurrent Hyperglycemia and Lactate Elevation with Hospital Outcomes in Emergency Department Sepsis Patients


Priyanka Shah


Dr. Ryan Arnold, Attending, Department of Emergency Medicine, Cooper University Hospital

Background: There is an association between hyperglycemia and hyperlactatemia with increased mortality in emergency department (ED) patients with severe sepsis (lactate>4.0). The association of hyperglycemia (glucose>200mg/dL) with elevated serum lactate in lower severity ED-sepsis patients may identify patients at increased risk for clinical deterioration. Objective: To determine whether concurrent glucose and lactate elevation were predictive of adverse hospital outcomes in the ED PRE-SHOCK sepsis patients. Sub-analysis of hyperglycemia on hospital outcome in diabetic and non-diabetic ED PRE-SHOCK patients. Methods: Retrospective analysis of a prospectively maintained registry of sepsis patients with lactate and glucose measurements. History of diabetes was included. The PRE-SHOCK population (adult ED-sepsis patients with elevated lactate (2.0–3.9mM) or transient hypotension (sBP<90mmHg) receiving IV-antibiotics and admitted to medical floor). Exclusions include overt shock in the ED, pregnancy, or acute trauma. We defined a primary patient-centered outcome of increased organ failure (sequential organ failure assessment [SOFA] score increase >1 point, mechanical ventilation or vasopressor utilization) within 72-hours of admission or in-hospital mortality. Secondary outcomes included ventilator-free days, ICU utilization, and hospital/ICU stay length. Results: We identified 248 PRE-SHOCK patients. The primary outcome was met in 54% of cohort and 44% were transferred to ICU from a medical floor. Patients meeting outcome of increased organ failure had greater Shock Indexes (1.02 vs.0.93,p=0.042) and HR (115 vs.105,p<0.001) with no difference in initial lactate, age, MAP or exposure to hypotension (sBP<100 mmHg). Outcome patients had similar initial levels of organ dysfunction, but higher SOFA scores at 24, 48, and 72-hours, higher ICU transfer rates (60 vs.24%,p<0.001) and increased ICU/hospital length of stays. The PRE-SHOCK population has high incidences of clinical deterioration, progressive organ failure, and ICU transfers. No significant difference was found between non-diabetic(3vs.5%) and diabetic(11vs.15%) hyperglycemic PRE-SHOCK patient outcomes. Aggressive glucose control in PRE-SHOCK patients does not necessarily prevent adverse hospital outcomes.

Presented by:

Priyanka Shah


Saturday, November 17, 2012




Broome Library

Presentation Type:

Poster Presentation