The importance of hyperosmolarity in diabetic ketoacidosis

Abstract

Aim Diabetic ketoacidosis is a hyperglycaemic emergency that is often treated in intensive care units (ICUs) despite having a low mortality and good prognosis. Current risk stratification is based primarily on acidosis, but it has been suggested that hyperosmolarity may also be an important marker of increased severity. Our aim was to evaluate the relationship between raised serum osmolarity and adverse clinical outcomes in ICU admissions for ketoacidosis. Methods Retrospective review of prospectively collected data for adult admissions with ketoacidosis in the Australian and New Zealand Intensive Care Society Adult Patient Database over a 15-year period (2004-2018). Exclusions were readmissions and records with critical missing data. Serum hyperosmolarity was defined as > 320 mosm/l. The primary outcome was hospital mortality; secondary outcomes were ICU mortality and other adverse clinical events. Results Some 17 379 admissions were included in the study population. People with hyperosmolarity had fourfold increased mortality, a higher incidence of renal failure and need for mechanical ventilation, and prolonged ICU and hospital length of stay. The relationship with mortality remained highly significant even after adjusting for severity of acidosis, hospital type, year of admission, time to ICU, and a modified Australia and New Zealand Risk of Death propensity score. Conclusions Although adults with ketoacidosis have a good prognosis overall, hyperosmolarity was independently associated with a significantly higher incidence of multiple adverse outcomes including mortality. Whether or not this is directly causal, it may have practical applications to improve risk stratification and identify individuals at risk of adverse outcomes.

Early Plasma Osmolality Levels and Clinical Outcomes in Children Admitted to the Pediatric Intensive Care Unit: A Single-Center Cohort Study

“…Measures of plasma osmolality, including crystal osmolality and colloid osmolality, which play important roles in regulating the distribution of water in blood vessels and inside and outside cells, are included in routine biochemical tests ( 2 ). Previous studies have shown that plasma osmolality is associated with the prognosis of patients with heart failure ( 3 , 4 ), myocardial infarction ( 5 , 6 ), and diabetic ketoacidosis ( 7 ), patients undergoing hemodialysis ( 8 ), elderly patients ( 9 ), and patients in the emergency room ( 10 , 11 ).…”

The association between plasma osmolality and in-hospital mortality in the first 24 h after neonatal intensive care unit admission

“…Disturbance of osmolality is associated with increased risks of adverse clinical outcomes in adults and children in critical care. Prior studies have shown that plasma osmolality is correlated with the prognosis of patients with diabetic ketoacidosis and myocardial infarction, elderly hemodialysis patients, and emergency room patients (4)(5)(6)(7)(8). Plasma osmolality is also associated with a higher rate of mortality and adverse cardiac events in heart failure patients (9).…”

Update malignes Melanom

“…Das Prinzip der neoadjuvanten Immuntherapie des fortgeschrittenen Melanoms sei aus seiner Sicht deshalb so spannend und aussichtsreich, weil bei der „perioperativen“ Therapie durch die größere Tumormasse mehr Neoantigene vorkommen und die immunologische Therapie besser wirken kann. Diese Verbesserung konnte mittlerweile als Proof-of-principle etwa mit einer Phase-I-Studie 1 oder der Phase-II-Studie SWOG S1801 2 auch klinisch gezeigt werden. Diese deutlich erkennbare Verbesserung des rezidivfreien Überlebens ist, so Mohr, „was wir für unsere Patienten wünschen“.…”