Short-term case fatality rate and associated factors among inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state

A hospital-based analysis over a 15-Year period

Hua Fen Chen, Chih Yuan Wang, Hsin Yu Lee, Ting Ting See, Mei Hsiu Chen, Ju Ying Jiang, Ming Tsang Lee, Chung-Yi Li

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background and Purpose Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. Our aim was to evaluate the 28-day case-fatality rate among hospitalized DKA and HHS patients in a teaching hospital in Taiwan from 1991 to 2005. Methods DKA and HHS admissions, identified from in-patient electronic database, were linked to Taiwan's national death registry. Kaplan-Meier analysis was used to determine the 28-day case-fatality rates of DKA and HHS, and to compare the trend of case-fatality over three consecutive 5-year periods (i.e, 1991-1995, 1996-2000, 2001-2005). We also used the Cox proportional hazard regression model to explore the determinants of 28-day case-fatality of the study patients. Results The 28-day case-fatality rates for DKA and HHS were 6.10% and 18.83%, and the lowest ones were observed in 2001-2005 (2.65% and 11.63% in DKA and HHS, respectively). Pneumonia was a significant predictor for increased 28-day case-fatality in both illnesses. Additionally, older age and stroke were significantly associated with increased case-fatality in DKA patients while myocardial infarction and higher Charlson index were significant predictors for higher case-fatality in HHS patients. Conclusion Improvements in case-fatality in recent years for both DKA and HHS were found in the study hospital. Further reduction of the case-fatality rate among DKA and HHS patients can be achieved by optimal management of certain co-morbidities.

Original languageEnglish
Pages (from-to)729-737
Number of pages9
JournalInternal Medicine
Volume49
Issue number8
DOIs
Publication statusPublished - 2010 Apr 15

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Hyperglycemic Hyperosmolar Nonketotic Coma
Diabetic Ketoacidosis
State Hospitals
Inpatients
Mortality
Taiwan
Kaplan-Meier Estimate
Proportional Hazards Models
Teaching Hospitals
Registries
Pneumonia

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Chen, Hua Fen ; Wang, Chih Yuan ; Lee, Hsin Yu ; See, Ting Ting ; Chen, Mei Hsiu ; Jiang, Ju Ying ; Lee, Ming Tsang ; Li, Chung-Yi. / Short-term case fatality rate and associated factors among inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state : A hospital-based analysis over a 15-Year period. In: Internal Medicine. 2010 ; Vol. 49, No. 8. pp. 729-737.
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abstract = "Background and Purpose Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. Our aim was to evaluate the 28-day case-fatality rate among hospitalized DKA and HHS patients in a teaching hospital in Taiwan from 1991 to 2005. Methods DKA and HHS admissions, identified from in-patient electronic database, were linked to Taiwan's national death registry. Kaplan-Meier analysis was used to determine the 28-day case-fatality rates of DKA and HHS, and to compare the trend of case-fatality over three consecutive 5-year periods (i.e, 1991-1995, 1996-2000, 2001-2005). We also used the Cox proportional hazard regression model to explore the determinants of 28-day case-fatality of the study patients. Results The 28-day case-fatality rates for DKA and HHS were 6.10{\%} and 18.83{\%}, and the lowest ones were observed in 2001-2005 (2.65{\%} and 11.63{\%} in DKA and HHS, respectively). Pneumonia was a significant predictor for increased 28-day case-fatality in both illnesses. Additionally, older age and stroke were significantly associated with increased case-fatality in DKA patients while myocardial infarction and higher Charlson index were significant predictors for higher case-fatality in HHS patients. Conclusion Improvements in case-fatality in recent years for both DKA and HHS were found in the study hospital. Further reduction of the case-fatality rate among DKA and HHS patients can be achieved by optimal management of certain co-morbidities.",
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Short-term case fatality rate and associated factors among inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state : A hospital-based analysis over a 15-Year period. / Chen, Hua Fen; Wang, Chih Yuan; Lee, Hsin Yu; See, Ting Ting; Chen, Mei Hsiu; Jiang, Ju Ying; Lee, Ming Tsang; Li, Chung-Yi.

In: Internal Medicine, Vol. 49, No. 8, 15.04.2010, p. 729-737.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Short-term case fatality rate and associated factors among inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state

T2 - A hospital-based analysis over a 15-Year period

AU - Chen, Hua Fen

AU - Wang, Chih Yuan

AU - Lee, Hsin Yu

AU - See, Ting Ting

AU - Chen, Mei Hsiu

AU - Jiang, Ju Ying

AU - Lee, Ming Tsang

AU - Li, Chung-Yi

PY - 2010/4/15

Y1 - 2010/4/15

N2 - Background and Purpose Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. Our aim was to evaluate the 28-day case-fatality rate among hospitalized DKA and HHS patients in a teaching hospital in Taiwan from 1991 to 2005. Methods DKA and HHS admissions, identified from in-patient electronic database, were linked to Taiwan's national death registry. Kaplan-Meier analysis was used to determine the 28-day case-fatality rates of DKA and HHS, and to compare the trend of case-fatality over three consecutive 5-year periods (i.e, 1991-1995, 1996-2000, 2001-2005). We also used the Cox proportional hazard regression model to explore the determinants of 28-day case-fatality of the study patients. Results The 28-day case-fatality rates for DKA and HHS were 6.10% and 18.83%, and the lowest ones were observed in 2001-2005 (2.65% and 11.63% in DKA and HHS, respectively). Pneumonia was a significant predictor for increased 28-day case-fatality in both illnesses. Additionally, older age and stroke were significantly associated with increased case-fatality in DKA patients while myocardial infarction and higher Charlson index were significant predictors for higher case-fatality in HHS patients. Conclusion Improvements in case-fatality in recent years for both DKA and HHS were found in the study hospital. Further reduction of the case-fatality rate among DKA and HHS patients can be achieved by optimal management of certain co-morbidities.

AB - Background and Purpose Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. Our aim was to evaluate the 28-day case-fatality rate among hospitalized DKA and HHS patients in a teaching hospital in Taiwan from 1991 to 2005. Methods DKA and HHS admissions, identified from in-patient electronic database, were linked to Taiwan's national death registry. Kaplan-Meier analysis was used to determine the 28-day case-fatality rates of DKA and HHS, and to compare the trend of case-fatality over three consecutive 5-year periods (i.e, 1991-1995, 1996-2000, 2001-2005). We also used the Cox proportional hazard regression model to explore the determinants of 28-day case-fatality of the study patients. Results The 28-day case-fatality rates for DKA and HHS were 6.10% and 18.83%, and the lowest ones were observed in 2001-2005 (2.65% and 11.63% in DKA and HHS, respectively). Pneumonia was a significant predictor for increased 28-day case-fatality in both illnesses. Additionally, older age and stroke were significantly associated with increased case-fatality in DKA patients while myocardial infarction and higher Charlson index were significant predictors for higher case-fatality in HHS patients. Conclusion Improvements in case-fatality in recent years for both DKA and HHS were found in the study hospital. Further reduction of the case-fatality rate among DKA and HHS patients can be achieved by optimal management of certain co-morbidities.

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