Inhospital Mortality in Patients with Type 2 Diabetes Mellitus: A Prospective Cohort Study in Lima, Peru

Abstract

Objective. To estimate cause of death and to identify factors associated with risk of inhospital mortality among patients with T2D. Methods. Prospective cohort study performed in a referral public hospital in Lima, Peru. The outcome was time until event, elapsed from hospital admission to discharge or death, and the exposure was the cause of hospital admission. Cox regression was used to evaluate associations of interest reporting Hazard Ratios (HR) and 95% confidence intervals. Results. 499 patients were enrolled. Main causes of death were exacerbation of chronic renal failure (38.1%), respiratory infections (35.7%), and stroke (16.7%). During hospital stay, 42 (8.4%) patients died. In multivariable models, respiratory infections (HR = 6.55, p < 0.001), stroke (HR = 7.05, p = 0.003), and acute renal failure (HR = 16.9, p = 0.001) increased the risk of death. In addition, having 2+ (HR = 7.75, p < 0.001) and 3+ (HR = 21.1, p < 0.001) conditions increased the risk of dying. Conclusion. Respiratory infections, stroke, and acute renal disease increased the risk of inhospital mortality among hospitalized patients with T2D. Infections are not the only cause of inhospital mortality. Certain causes of hospitalization require standardized and aggressive management to decrease mortality.

Factors Associated with Death in Subjects Admitted for a Diabetological Emergency: Experience of the Medical Clinic II of the Abass Ndao Hospital Center in Dakar (Senegal) —Death in Diabetic Emergencies

“…On the glycemic level, these were hyperglycemic emergencies (ketoacidosis and diabetic hyperosmolarity syndrome) in 29.8% and hypoglycaemic in 6.7% [8]. Our series, like most data in the literature, found infections and vascular pathologies respectively in second and third place as causes of diabetological emergencies [8] [19]. In these last two groups, the septic or mixed diabetic foot is a common and predominant reason for hospitalization.…”

“…Infection does not appear to be a significant factor in poor prognosis [7]. A significant deleterious effect of respiratory infections associated with diabetic emergencies was reported by Zelada et al [19]. In subgroup analysis, the negative impact of the infected or mixed diabetic foot remains unanimously recognized [6] [8].…”

“…Kidney failure can be a factor of aggravation. In some studies, it is found in 17% [6] to 18% [19] of cases of diabetological emergencies.…”

“…In a study in the United Kingdom, among the 9.8% cause of death in type 2 diabetics, cardiovascular factors were reported in 3% [23]. These were mainly stroke [7] [8] [19] and to a lesser extent coronary heart disease and lower limb arteriopathy [6].…”

Prevalence of diabetes and its effects on stroke outcomes: A meta‐analysis and literature review

“…Diabetes has been associated with an increased all-cause inhospital mortality in general hospital inpatients, with a higher contribution from a cerebrovascular cause 4,10,[88][89][90] . Diabetes is associated with atherothrombotic strokes, whereas cardioembolic strokes are more common in patients without diabetes 8,14,26,46 .…”