Predicting the hyperglycemic crisis death (PHD) score: A new decision rule for emergency and critical care

Chien Cheng Huang, Shu Chun Kuo, Tsair Wei Chien, Hung Jung Lin, How Ran Guo, Wei Lung Chen, Jiann Hwa Chen, Su Hen Chang, Shih Bin Su

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


AbstractBackground We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups. Methods This study was done in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled when they met the criteria of a hyperglycemic crisis. Data were separated into derivation and validation sets - the former were used to predict the latter. December 31, 2008, was the cutoff date. Thirty-day mortality was the primary endpoint. Results We enrolled 295 patients who made 330 visits to the ED: derivation set = 235 visits (25 deaths: 10.6%), validation set = 95 visits (10 deaths: 10.5%). We found 6 independent mortality predictors: Absent tachycardia, Hypotension, Anemia, Severe coma, Cancer history, and Infection (AHA.SCI). After assigning weights to each predictor, we developed a Predicting Hyperglycemic crisis Death (PHD) score that stratifies patients into mortality-risk and disposition groups: low (0%) (95% CI, 0-0.02%): treatment in a general ward or the ED; intermediate (24.5%) (95% CI, 14.8-39.9%): the intensive care unit or a general ward; and high (59.5%) (95% CI, 42.2-74.8%): the intensive care unit. The area under the curve for the rule was 0.946 in the derivation set and 0.925 in the validation set. Conclusions The PHD score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in adult patients with hyperglycemic crises.

Original languageEnglish
Pages (from-to)830-834
Number of pages5
JournalAmerican Journal of Emergency Medicine
Issue number5
Publication statusPublished - 2013 May

All Science Journal Classification (ASJC) codes

  • Emergency Medicine


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