Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study
Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study
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DOI：
10.2337/dc19-1168
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发表时间：
2020-02-01
期刊：
影响因子：
16.2
通讯作者：
Umpierrez, Guillermo E.
中科院分区：
文献类型：
--
作者：
Pasquel, Francisco J.;Tsegka, Katerina;Umpierrez, Guillermo E.
目的 许多高血糖危象患者具有糖尿病酮症酸中毒（DKA）和高渗性高血糖状态（HHS）的综合特征。伴随酸中毒和高渗透压的影响尚不清楚。我们调查了孤立或合并高血糖危象患者的医院结局。研究设计和方法 我们分析了两家学术医院列出 DKA 或 HHS 的入院数据。我们确定了 1) HHS、DKA 和组合 DKA-HHS（DKA 标准加上有效渗透压升高）的频率分布； 2) 疾病严重程度和临床合并症的标志物与 30 天全因死亡率的关系； 3) 与胰岛素治疗相关的医院并发症（低血糖和低钾血症）与死亡率的关系。结果 首次入院的 1,211 名患者具有确诊的高血糖危象标准，其中 465 名患者（38%）患有孤立性 DKA，421 名患者（35%）患有孤立性 HHS，325 名患者（27%）具有 DKA-HHS 综合特征。调整年龄、性别、BMI、种族和查尔森合并症指数评分后，与单纯高血糖危象受试者相比，合并 DKA-HHS 的受试者院内死亡率更高（调整后比值比 [aOR] 2.7；95% CI 1.4, 4.9；P = 0.0019）。在所有组中，低血糖（
OBJECTIVE Many patients with hyperglycemic crises present with combined features of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The implications of concomitant acidosis and hyperosmolality are not well known. We investigated hospital outcomes in patients with isolated or combined hyperglycemic crises. RESEARCH DESIGN AND METHODS We analyzed admissions data listing DKA or HHS at two academic hospitals. We determined 1) the frequency distributions of HHS, DKA, and combined DKA-HHS (DKA criteria plus elevated effective osmolality); 2) the relationship of markers of severity of illness and clinical comorbidities with 30-day all-cause mortality; and 3) the relationship of hospital complications associated with insulin therapy (hypoglycemia and hypokalemia) with mortality. RESULTS There were 1,211 patients who had a first admission with confirmed hyperglycemic crises criteria, 465 (38%) who had isolated DKA, 421 (35%) who had isolated HHS, and 325 (27%) who had combined features of DKA-HHS. After adjustment for age, sex, BMI, race, and Charlson Comorbidity Index score, subjects with combined DKA-HHS had higher in-hospital mortality compared with subjects with isolated hyperglycemic crises (adjusted odds ratio [aOR] 2.7; 95% CI 1.4, 4.9; P = 0.0019). In all groups, hypoglycemia (