Predictors and treatment outcome of hyperglycemic emergencies: a one-center experience

Abstract

Background Hyperglycemic emergencies (HEs) are serious acute complications of uncontrolled diabetes, which can be life threatening. In spite of major advances in diagnosis and treatment, it still is an important cause of morbidity and mortality. Aims To evaluate treatment outcomes among diabetic patients presented with HEs and to ascertain the determinants and factors associated with the outcome. Patients and methods This prospective, longitudinal study was conducted on 240 diabetic patients presented with HEs at Specialized Medical Hospital, Mansoura University. They were subjected to full history, physical examination, laboratory assessment, and follow-up. According to the laboratory results, patients were divided into three groups: diabetic ketoacidosis (DKA); hyperglycemic hyperosmolar nonketotic state (HHS); and normo-osmolar nonketotic hyperglycemic state. Results The study included 82 men and 158 women. The most common HE was DKA. Nonadherence to medications was the most common cause of DKA and normo-osmolar nonketotic hyperglycemic state (52.1 and 47.8%, respectively). The overall hospital mortality due to HEs was 12.5%. The highest mortality was recorded in the HHS group (51.7%). Mortality was higher in old-aged, nonobese patients, and in those without education. Nonsurvivors had longer duration of ICU stay than survivors, with no difference in total hospital stay. No hypoglycemic episodes detected in the nonsurvived group versus 37 episodes in the survived one. There were significant associations between mortality and Glasgow coma scale, the presenting and the highest random plasma glucose, serum sodium, osmolarity, creatinine, white blood cells, and glycated hemoglobin. Conclusion DKA is the most common HE, while HHS has the highest mortality rate. The strongest predictors of mortality of HEs are HHS, DKA in type 2 diabetes, old age, chronic kidney disease, coronary artery disease, highest random plasma glucose, glycated hemoglobin, and length of ICU stay.