Emergency Department Triage Blood Glucose Levels: Outcomes Implications in Patients with Severe Sepsis and Septic Shock
Schoenling A, Hamam M, Jaehne AK, Calo S, Gill J, Krupp S, and Rivers EP. Emergency department triage blood glucose levels: Outcomes implications in patients with severe sepsis and septic shock. Acad Emerg Med 2017; 24:S240.
Acad Emerg Med
Background: Patients with severe sepsis and septic shock often present with a variety of organ dysfunctions including metabolic derangements. The appropriate metabolic stress response in sepsis includes release of glucose leading to stress-hyperglycemia and is commonly seen in these Emergency Department (ED) patients. Many studies focus on metabolic glucose abnormalities and its effect on outcomes at the time of Intensive Care Unit (ICU) admission. Hyperglycemia present on ICU admission has been associated with adverse outcomes irrespective of the presence or absence of diabetes mellitus. Methods: We analyzed our ED quality sepsis database in concern to triage glucose levels and associated 30 day mortality from August 2015 to October 2016 to determine adjustments in active glucose monitoring in the ED. Results: We identified 683 patients with severe sepsis (N=399) and septic shock (N=284). Average glucose levels at the 1stED laboratory evaluation was 172 mg/ dL (SD=149). Patients with septic shock had on average lower glucose levels (170 mg/dL) than patients with severe sepsis (174 mg/dL). Sepsis survivors had higher triage glucose (176 mg/dL, N=525) than non-survivors (159 mg/dL, N=157). When stratifying patients by glucose levels, we found that patients with glucose levels less than 70 mg/dL at ED triage had the highest mortality. The incidence of glucose of ≤ 70 mg/ dL was 7% (N=49) for all patients with severe sepsis and septic shock combined. The mortality in this group was 44% (21/49) which was significantly (p=0.001) higher than mortality in patients with higher glucose levels (136/634, 21%). In patients with glucose levels of ≥ 180 mg/dL the mortality was not different (35/177, 26%, p=0.9) when compared to patients with glucose levels ranging from 70-180 mg/dL. Conclusion: Glucose monitoring for patients with sepsis in the ED aids recognition of correctable metabolic derangements early in management. In the ED, the metabolic-stress response to sepsis is commonly stress-hyperglycemia, but hypoglycemia can also occur in the early phases of sepsis. Hypoglycemia at ED triage has a higher than expected mortality and needs to be recognized and treated accordingly.