{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:27:27Z","timestamp":1747182447800,"version":"3.40.5"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["RG220183"],"award-info":[{"award-number":["RG220183"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the relationship between point\u2010of\u2010care \u03b2\u2010hydroxybutyrate (BHB) concentration and outcomes in adult patients without diabetes admitted through ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective study from 10 March to 2 July 2021. Admitted patients without diabetes had capillary BHB sampled in ED. Outcomes of length\u2010of\u2010stay (LOS), composite mortality\/ICU admission rates and clinical severity scores (Quick Sepsis Organ Failure Assessment score\/National Early Warning Score [qSOFA\/NEWS]) were measured. BHB was assessed as a continuous variable and between those with BHB above and equal to 1.0\u2009mmol\/L and those below 1.0\u2009mmol\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 311 patients were included from 2377 admissions. Median length\u2010of\u2010stay was 4.1\u2009days (IQR 2.1\u20139.8), 18 (5.8%) died and 37 (11.8%) were admitted to ICU. Median BHB was 0.2\u2009mmol\/L (IQR 0.1\u20130.4). Twenty\u2010five patients had BHB \u22651.0\u2009mmol\/L and five were &gt;3.0\u2009mmol\/L. There was no significant difference in median LOS for patients with BHB \u22651.0\u2009mmol\/L compared to non\u2010ketotic patients, 5.3\u2009days (IQR 2.2\u20137.5) <jats:italic>versus<\/jats:italic> 4.1\u2009days, respectively (IQR 2.0\u20139.8) (<jats:italic>P<\/jats:italic>\u2009=\u20090.69). BHB did not correlate with LOS (Spearman \u03c1\u2009=\u20090.116, 95% confidence interval: 0.006\u20130.223). qSOFA and NEWS also did not differ between these cohorts. For those 25 patients with BHB \u22651.0\u2009mmol\/L, an infective\/inflammatory diagnosis was present in 11 (44%), at least 2\u2009days of fasting in 10 (40%) and ethanol intake &gt;40\u2009g within 48\u2009h in 4 (16%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Routine BHB measurement in patients without diabetes does not add to clinical bedside assessment and use should be limited to when required to confirm a clinical impression.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.14393","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T04:44:53Z","timestamp":1709613893000},"page":"527-535","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical significance of an elevated on\u2010admission beta\u2010hydroxybutyrate in acutely ill adult patients without diabetes"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3438-7666","authenticated-orcid":false,"given":"Samuel","family":"Lin","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of New South Wales  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Depczynski","sequence":"additional","affiliation":[{"name":"Prince of Wales Hospital South Eastern Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4752-9679","authenticated-orcid":false,"given":"Wayne","family":"Varndell","sequence":"additional","affiliation":[{"name":"Prince of Wales Hospital South Eastern Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su An","family":"Hui","sequence":"additional","affiliation":[{"name":"Yong Yoo Lin School of Medicine National University of Singapore  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-5056","authenticated-orcid":false,"given":"Angela","family":"Chiew","sequence":"additional","affiliation":[{"name":"Prince of Wales Hospital South Eastern Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0147-9563(99)70028-2"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2016.12.022"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-nutr-071816-064916"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-7560(199911\/12)15:6<412::AID-DMRR72>3.0.CO;2-8"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2006.035758"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000000330"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12256"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-023-02203-7"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cellsig.2016.04.005"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-40007-5_51-1"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmed.2020-0012"},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","unstructured":"HeidenreichPA BozkurtB AguilarDet al.2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines.2022;145:e895\u2013e1032.","DOI":"10.1161\/CIR.0000000000001073"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1179\/1743132813Y.0000000239"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-021-01725-7"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2019.12.009"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-S016"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17228367"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2018.01.006"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-5491.2001.00550.x"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.2337\/db15-1356"},{"key":"e_1_2_9_22_1","unstructured":"Australian Commission on Safety and Quality in Health Care.Lactate in the Deteriorating Patient. 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[Cited 8 Nov 2022.] Available from URL:https:\/\/www.rcplondon.ac.uk\/projects\/outputs\/national\u2010early\u2010warning\u2010score\u2010news\u20102"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-0256"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1804600506"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1911303"},{"key":"e_1_2_9_27_1","article-title":"Stress\u2010induced hyperglycemia: consequences and management","volume":"14","author":"Vedantam D","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7387128"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc23-1163"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.01.016"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-022-05128-8"}],"container-title":["Emergency Medicine Australasia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1742-6723.14393","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T02:38:29Z","timestamp":1721183909000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1742-6723.14393"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,4]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1111\/1742-6723.14393"],"URL":"https:\/\/doi.org\/10.1111\/1742-6723.14393","archive":["Portico"],"relation":{},"ISSN":["1742-6731","1742-6723"],"issn-type":[{"type":"print","value":"1742-6731"},{"type":"electronic","value":"1742-6723"}],"subject":[],"published":{"date-parts":[[2024,3,4]]},"assertion":[{"value":"2023-11-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}