Association of Glucose Concentrations at Hospital Discharge With Readmissions and Mortality: A Nationwide Cohort Study

被引:22
作者
Spanakis, Elias K. [1 ,2 ]
Umpierrez, Guillermo E. [3 ]
Siddiqui, Tariq [2 ,6 ]
Zhan, Min [4 ]
Snitker, Soren [2 ,5 ]
Fink, Jeffrey C. [5 ,6 ]
Sorkin, John D. [7 ]
机构
[1] Baltimore Vet Affairs Med Ctr, Div Endocrinol, Baltimore, MD 21201 USA
[2] Univ Maryland, Sch Med, Div Endocrinol Diabet & Nutr, Baltimore, MD 21201 USA
[3] Emory Univ, Sch Med, Div Endocrinol Metab & Lipids, Atlanta, GA 30303 USA
[4] Univ Maryland, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA
[5] Univ Maryland, Sch Med, Dept Med, Baltimore, MD 21201 USA
[6] Univ Maryland, Sch Med, Div Nephrol, Baltimore, MD 21201 USA
[7] Baltimore Vet Affairs Med Ctr Geriatr Res Educ &, Baltimore, MD 21201 USA
关键词
LENGTH-OF-STAY; LONGITUDINAL DATA-ANALYSIS; MEDICARE BENEFICIARIES; MYOCARDIAL-INFARCTION; 30-DAY READMISSION; RISK-FACTORS; HYPOGLYCEMIA; VETERANS; OUTCOMES; REHOSPITALIZATIONS;
D O I
10.1210/jc.2018-02575
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Low blood glucose concentrations during the discharge day may affect 30-day readmission and posthospital discharge mortality rates. Objective: To investigate whether patients with diabetes and low glucose values during the last day of hospitalization are at increased risk of readmission Design and Outcomes: Minimum point of care glucose values were collected during the last 24 hours of hospitalization. We used adjusted rates of 30-day readmission rate, 30-, 90-, and 180-day mortality rates, and combined 30-day readmission/mortality rate to identify minimum glucose thresholds above which patients can be safely discharged. Patients and Setting: Nationwide cohort study including 843,978 admissions of patients with diabetes at the Veteran Affairs hospitals 14 years. Results: The rate ratios (RRs) increased progressively for all five outcomes as the minimum glucose concentrations progressively decreased below the 90 to 99 mg/dL category, compared with the 100 to 109 mg/dL category: 30-day readmission RR, 1.01 to 1.45; 30-day readmission/mortality RR, 1.01 to 1.71; 30-day mortality RR, 0.99 to 5.82; 90-day mortality RR, 1.01 to 2.40; 180-day mortality RR, 1.03 to 1.91. Patients with diabetes experienced greater 30-day readmission rates, 30-, 90- and 180-day postdischarge mortality rates, and higher combined 30-day readmission/mortality rates, with glucose levels <92.9 mg/dL, <45.2 mg/dL, 65.8 mg/dL, 67.3 mg/dL, and <87.2 mg/dL, respectively. Conclusion: Patients with diabetes who had hypoglycemia or near-normal glucose values during the last day of hospitalization had higher rates of 30-day readmission and postdischarge mortality.
引用
收藏
页码:3679 / 3691
页数:13
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