Treatment outcome and prognostic indices in patients with hyperglycemic emergencies

Ezeani, IU; Eregie, A; Ogedengbe, OS

doi:10.2147/dmso.s44477

Cited by 23 publications

(22 citation statements)

References 15 publications

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“…HHS was the major HE case. This nding goes in line with studies from Nigeria and Taiwan (15,(24)(25)(26)(27) but stands against a study reported that DKA was the commonest HE (22). The higher prevalence of HHS in our study might be explained by the fact that the majority of the study participants were T2DM patients, and that HHS often raids patients with uncontrolled T2DM (28).…”

Section: Discussionsupporting

confidence: 90%

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Treatment Outcome Of Hyperglycemic Emergency And Predictors In Ethiopia

Tekeste

Mekonnen

Muche

et al. 2020

Preprint

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Background: Hyperglycemic Emergency (HE) denotes critical cases of decompensated diabetes mellitus (DM). Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the extreme cases of HE. This study aims to assess the treatment outcome of HE and predictors in Ethiopia.Method: Four-year medical records of DM patients admitted for HE at Hiwot Fana Specialized University Hospital (HFSUH) were reviewed retrospectively. Data were entered into and cleaned by Epi-InfoTM7 software. The statistical analysis was executed using the statistical package for social sciences software (SPSS) version 24. Chi-square test and student’s t-test were done to compare categorical and continuous variables. Logistic regression with the level of α set at 0.05 and AOR of 95% CI was done to determine the predictors. Statistical significance was established at AOR ≠1 within a 95% CI and P-value < 0.05. The model was verified using the Hosmer-Lemeshow goodness of fit test (P = 0.392).Results: This study included 321 eligible patients. The median duration of hospital stay was 7 days. The pooled HE mortality was 16.5%; 21.4% of HHS and 11.1% of DKA died. Infection (AOR = 3.74, 95% CI: 1.85-7.57, P <0.001), comorbidity (AOR = 2.95, 95% CI: 1.34-6.48, P = 0.007), and lower admission Glasgow Coma Scale score ≤ 8 (AOR = 2.58, 95% CI: 1.17-5.71, P = 0.019) were the independent predictors of HE mortality.Conclusion: Mortality and duration of hospital stay stand high among DM patients admitted with HE. Infection, comorbidity, and lower admission GCS ≤ 8 are the independent predictors of HE mortality.

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Section: Discussionsupporting

confidence: 90%

“…The median length of hospital stay in our study was 7 days. Even though this is shorter than the ndings of studies from Nigeria and Colombia (5,24,25), it still is longer than the reports from Jimma and South…”

Section: Discussionmentioning

confidence: 64%

Treatment Outcome Of Hyperglycemic Emergency And Predictors In Ethiopia

Tekeste

Mekonnen

Muche

et al. 2020

Preprint

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“…21,22,10,12 . With better understanding of the pathophysiology of DKA and improvements in treatment, outcome is improving 23,24 .…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcome of Diabetic Ketoacidosis: Experience at BIRDEM, Dhaka, Bangladesh

Rahim

Rouf

Ahmed

et al. 2015

Bangladesh Crit Care J

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Background: Diabetic ketoacidosis (DKA) is a medical emergency. It may be the presenting feature of diabetes mellitus, but more commonly DKA complicates diabetic patients during inter-current acute illness or if they become non-compliant to anti-diabetic medications. Early detection and treatment of DKA including underlying cause is important in determining outcome.Objectives: To describe the demographic characteristics, presentations, precipitating factors and outcome of DKA.Methods: This cross-sectional study was conducted at BIRDEM General Hospital from January 2008 to December 2011.Results: Total patients were 200 with female predominance (56%). Mean age of the study population was 37.6 years. Incidence of DKA was more in known diabetic patients (71%) than in new cases (29%), more among rural population (53%) and low income group (76.5%). Common presentations included nausea (63%), vomiting (61%), polyuria (43%), polydypsia (42.5%), fever (29%), abdominal pain (28%), shortness of breath (28%), drowsiness (20%), blurred vision (13%), leg cramps (6.5%) and coma (7%). Infection (45.5%) was the commonest precipitating cause of DKA followed by non-adherence to insulin therapy (31%). Acute pancreatitis (5%), myocardial infarction (2%), stroke (1%) and surgery (1.5%) were less common precipitating factors. Aetiology of DKA could not be identified in 14% cases. Mean random blood glucose during admission was 27.1mmol/L and mean HbA1c was 11.3%. Severe acidosis (pH<7) was less common (8.5%). Neutrophil leukocytosis was present in 87% cases, irrespective of infection. In-hospital mortality was 6.5%.Conclusion: DKA occurred in diabetic patients in over two-third of the cases. In over two-third of the study population, DKA was precipitated by infection and non-adherence to insulin treatment. So, patient education regarding treatment compliance and sick days management are important and may prevent many cases of DKABangladesh Crit Care J September 2015; 3 (2): 53-56

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“…DKA is prone to occur in patients with Type 1 diabetes (T1DM) spontaneously [3], yet several studies suggested that each type of diabetes may be associated with DKA, and more DKA occurs in Type 2 diabetes (T2DM) [3]. Previous researches on DKA were often conducted in developed countries such as Europe, America, or Japan [4][5][6], nevertheless so far research data of patients with HEs from mainland China were limited, especially on the overall precipitants, clinical features, treatment outcomes and risk factors.…”

Section: Introductionmentioning

confidence: 99%

Clinical profiles, Outcomes and Risk Factors among Type 2 Diabetic Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 6-Year Period

She

Wang

et al. 2020

Preprint

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Objective：Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most common hyperglycemic emergencies (HEs) associated with diabetes mellitus. Individuals with HEs can present with combined features of DKA and HHS. The objective of this study is to assess the clinical characteristics, therapeutic outcomes, and associated predisposing factors of type 2 diabetic patients with isolated or combined HEs in China. Methods: We performed a retrospective analysis of 158 patients with type 2 diabetes (T2DM), complicated with DKA, HHS, or DKA combined with HHS (DKA-HHS) in Shanghai Tongji Hospital, China from 2010 to 2015. Admission clinical features, therapeutic approaches and treatment outcomes of those patients were extracted and analyzed.Results: Of the 158 patients with T2DM, 65 (41.1%) patients were DKA, 74 (46.8%) were HHS, and 19 (12.0%) were DKA-HHS. The most common precipitants were infections (111, 70.3%), newly diagnosed diabetes (28,17.7%) and non-compliance to medications (9, 5.7%). DKA patients were divided into mild, moderate and severe group, based on arterial blood gas. Spearman correlation analysis revealed that C-reaction protein (CRP) was positively correlated with severity of DKA, whereas age and fasting C peptide were inversely correlated with severity of DKA (P<0.05). The mortality was 10.8% (17/158) in total and 21.6% (16/74) in the HHS group, 5.9% (1/17) in DKA-HHS. Spearman correlation analysis indicated that lethal outcome of HHS patients was positively correlated to effective plasma osmolality (EPO), renal function indicators and hepatic enzymes, while inversely associated with the continuous subcutaneous insulin infusion (CSII) therapy. Logistic regression analysis suggested that elevated blood urea nitrogen (BUN) on admission was an independent predisposing factor of mortality in HHS, while CSII might be a protective factor for patients with HHS. Furthermore, the receiver-operating characteristic (ROC) curve analysis indicated that BUN had the largest area under the ROC curves for predicting lethal outcome in patients with HHS.Conclusions: Our findings showed elevated CRP and decreased fasting C-peptide might serve as indicator for severe DKA. Elevated BUN might be an independent predictor of mortality in patients with HHS, whereas CSII might be a protective factor against lethal outcome in HHS.

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Treatment outcome and prognostic indices in patients with hyperglycemic emergencies

Cited by 23 publications

References 15 publications

Treatment Outcome Of Hyperglycemic Emergency And Predictors In Ethiopia

Treatment Outcome Of Hyperglycemic Emergency And Predictors In Ethiopia

Clinical Characteristics and Outcome of Diabetic Ketoacidosis: Experience at BIRDEM, Dhaka, Bangladesh

Clinical profiles, Outcomes and Risk Factors among Type 2 Diabetic Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 6-Year Period

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