Exp Clin Endocrinol Diabetes 2018; 126(09): 564-569
DOI: 10.1055/s-0043-117416
Article
© Georg Thieme Verlag KG Stuttgart · New York

The Impact of Hyperosmolarity on Long-Term Outcome in Patients Presenting with Severe Hyperglycemic Crisis: A Population Based Study

Ivan Kruljac
1   Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Zagreb, Croatia
,
Miroslav Ćaćić
1   Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Zagreb, Croatia
,
Petra Ćaćić
1   Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Zagreb, Croatia
,
Lora Stanka Kirigin Biloš
1   Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Zagreb, Croatia
,
Davor Kust
2   Department of Oncology and Nuclear medicine, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Zagreb, Croatia
,
Božidar Perić
1   Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Zagreb, Croatia
,
Maja Filipović-Grčić
1   Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Zagreb, Croatia
,
Gorana Mirošević
1   Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Zagreb, Croatia
,
Vedran Ostojić
3   Department of Internal medicine, University Hospital “Sveti Duh”, Zagreb, Croatia
,
Mario Štefanović
4   Clinical Institute of Chemistry, University Hospital Center “Sestre Milosrdnice”, University of Zagreb Faculty of Pharmacy and Biochemistry
,
Milan Vrkljan
1   Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Zagreb, Croatia
› Author Affiliations
Further Information

Publication History

received 17 May 2017
first decision 15 July 2017

accepted 19 July 2017

Publication Date:
17 November 2017 (online)

Abstract

Aims We compared characteristics of patients with hyperglycemic hyperosmolar state (HHS) and patients with severe hyperglycemia without the signs of hyperosmolarity and ketoacidosis; analyzed long-term all-cause mortality and potential prognostic factors.

Methods The studied population included 261 749 adults. HHS was diagnosed in patients with plasma glucose >33.0 mmol/L, ketonuria <1+, and serum osmolarity >320 mmol/L. Patients with plasma glucose >33.0 mmol/L, ketonuria <1+ and serum osmolarity <320 mmol/L were considered as controls (nHHS).

Results During the 5-year period, we observed 68 episodes of HHS in 66 patients and 51 patients with nHHS. Patients with HHS were significantly older, had lower BMI, higher serum C-reactive protein and used diuretics and benzodiazepines more frequently. Mortality rates one, three and 12 months after admission were 19.0, 32.1 and 35.7% in the HHS group, and 4.8, 6.3 and 9.4% in the nHHS group (P<0.001). However, after adjustment for patient age, these differences were not statistically significant. In multivariate Cox regression in HHS group, mortality was positively associated with age, male gender, leukocyte count, amylase, presence of dyspnea and altered mental status, and the use of benzodiazepines, ACE inhibitors and sulphonylureas, while it was inversely associated with plasma glucose, bicarbonate, and the use of thiazides and statins. A nomogram derived from these variables had an accuracy of 89% in predicting lethal outcome.

Conclusions Infection, use of furosemide and benzodiazepines may be important precipitating factors of HHS. Prospective clinical trials are mandatory to analyze the safety of ACE-inhibitors and benzodiazepines in elderly patients with diabetes.