Abstract Details

Title Intravenous Glucose without Thiamine is Associated with Increased Mortality in Hospitalized Patients with Acute Encephalopathy

Topic General Neurology

Presentation(s) General Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 082

Objective To determine association between timing of supplemental thiamine, intravenous (IV) glucose, and outcomes in hospitalized patients with acute encephalopathy.

Background Thiamine deficiency, a common cause of encephalopathy in hospitalized patients, is difficult to diagnose clinically. The effect of routine thiamine supplementation on hospital outcomes in these patients remains unclear.

Design/Methods In our IRB-approved study, we extracted demographic, clinical, and medication data for adult patients, with index admission during calendar year 2017 and ICD-10 codes associated with encephalopathy from our hospital’s electronic health record database. Patients were assigned to group T₁ (received thiamine before/with IV glucose), G₁ (received IV glucose before/without thiamine), or control (received neither). We modeled association of groups on primary outcomes: hospital length of stay (LOS), mortality, and 90-day readmission rates.

Results We identified 985 patients: 365 (37.1%) in T_1,123 (12.5%) in G₁, and 497 (50.5%) in control group. Compared to control, G₁ had increased risk for in-hospital mortality (adjusted hazard ratio 4.91; 95% confidence interval 1.82-13.22; p=0.002; Cox proportional hazard) and 90-day mortality (AHR 2.02; 95% CI 1.34-3.06; p=0.001), while T₁ was not significantly different for in-hospital mortality (AHR 1.72; 95% CI 0.44-6.66; p=0.43) and 90-day mortality (AHR 1.51; 95% CI 0.83-2.76; p=0.18). Adjusted mean log LOS was significantly higher in both T₁ (AHR 0.36; 95% CI 0.24-0.49; p<0.0001) and G₁ (AHR 0.31; 95% CI 0.22-0.39; p<0.0001) compared to control (linear regression). G₁ (adjusted odds ratio 1.04; 95% CI 0.72-1.51; p=0.96) and T₁ (AOR 1.03; 95% CI 0.60-1.78; p=0.99) showed no significant difference in 90-day readmission rates compared to control (logistic regression).

Conclusions There was increased risk of mortality in hospitalized patients with encephalopathy who received IV glucose before or without thiamine. This may be due to increased metabolic demand, resulting in lactate buildup. We recommend thiamine supplementation prior to administrating IV glucose products in hospitalized patients with acute encephalopathy.

Authors/Disclosures
Daniel Zhou, MD (University of Pennsylvania) PRESENTER	The institution of Dr. Zhou has received research support from American Epilepsy Society. The institution of Dr. Zhou has received research support from National Institutes of Health.
Navya Joseph, MD (Bryan Physicians Network)	Dr. Joseph has nothing to disclose.
Kaeli Samson	No disclosure on file
Matthew Purbaugh, MD (Bryan Physician Network)	Dr. Purbaugh has nothing to disclose.
Brian J. Villafuerte Trisolini, MD (University of Nebraska Medical Center)	Dr. Villafuerte Trisolini has nothing to disclose.
	No disclosure on file
	No disclosure on file
Sachin Kedar, MD, FAAN (Emory University School of Medicine)	Dr. Kedar has nothing to disclose.

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