Introduction: Critical illness is commonly complicated by hyperglycaemia caused by mediators of stress and inflammation. Severity of disease is the main risk factor for development of hyperglycaemia, but not all severely ill develop hyperglycemia and some do even in mild disease. We hypothesised that acute disease only exposes a latent disturbance of glucose metabolism which puts those patients at higher risk for developing diabetes. Methods: Medical patients with no history of impaired glucose metabolism or other endocrine disorder admitted to an intensive care unit between July 1998 and June 2004 were considered for inclusion. Glucose was measured at least two times a day, and patients were divided into the hyperglycaemia group (glucose ≥7.8 mmol/l) and normoglycaemia group. An oral glucose tolerance test was performed within six weeks after discharge to disclose patients with unknown diabetes or pre-diabetes who were excluded. Patients treated with corticosteroids and those terminally ill were also excluded from the follow-up which lasted for a minimum of five years with annual oral glucose tolerance tests. Results: A five-year follow-up was completed for 398 patients in the normoglycaemia group, of which 14 (3.5%) developed type 2 diabetes. In the hyperglycaemia group 193 patients finished follow-up and 33 (17.1%) developed type 2 diabetes. The relative risk for type 2 diabetes during five years after the acute illness was 5.6 (95% confidence interval (CI) 3.1 to 10.2). Conclusions: Patients with hyperglycaemia during acute illness who are not diagnosed with diabetes before or during the hospitalization should be considered a population at increased risk for developing diabetes. They should, therefore, be followed-up, in order to be timely diagnosed and treated.

Objectives: To establish age-adjusted cut-off values for glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and assess their impact on the diagnostic performance of the mild traumatic brain injury (mTBI) assay. Methods: The study included 175 adult mTBI patients presenting at the emergency department (ED) within 12 h from head trauma in whom head CT scan was performed. GFAP and UCH-L1 were measured using chemiluminescence immunoassays on an Abbott analyzer (Abbott Laboratories, USA). Results: Using manufacturer’s defined cut-offs (GFAP < 35 ng/L, UCH-L1 < 400 ng/L), the mTBI assay exhibited diagnostic sensitivity (Se) of 93.1%, specificity (Sp) of 28.8%, negative predictive value (NPV) of 95.5% and a positive predictive value (PPV) of 20.6%. In the subgroup of patients aged under 50, Se and NPV were below 100% (i.e., 75.0% and 92.3%), due to two false negative mTBI results. Age-adjusted cut-offs were defined for three patient groups, ≤49 years, 50–69 years and ≥70 years, and were set to 22.4, 37.0 and 62.3 ng/L for GFAP, and 349.3, 351.6 and 369.0 ng/L for UCH-L1. Using these cut-offs, in all patient groups Se and NPV were 100%, while increased Sp was obtained in patients older than 50 years. Conclusions: Diagnostic Se and NPV can be improved by the use of age-adjusted cut-offs. In this way, the triage protocol for mTBI and head CT scan can be refined, further contributing to the optimization of the diagnostic management of mTBI patients at the ED.