Analysis The Correlation Between The Clinical Outcome Of Hyperglycemic Crisis And Different Diagnostic Guidelines

Objective:Hyperglycemic Crisis Episode(HCE)is a common acute decompensated complication of diabetes mellitus,including Diabetic Ketoacidosis(DKA),Hyperosmolar Hyperglycemic State(HHS),and combined DKA and HHS,seriously affecting the quality of life and life safety of patients.Despite the seriousness of HCE,the diagnostic criteria for DKA and HHS have not yet been agreed upon by different international guidelines.As for the diagnosis and treatment specifications of DKA patients in the acute and transitional stages,the opinions of experts from different countries are not completely unified.There have been few prospective studies to determine the best treatment strategy for managing patients with HHS.The purpose of this study was to compare the differences in clinical characteristics and prognosis of HCE according to different international guidelines;to explore the possible causes of early onset,recurrent attacks,severe complications,and death in patients with HCE;and provide a historical perspective for early intervention and improve the long-term outcome for HCE in the future.Methods:500 patients with HCE were included from August 1,2017to May 1,2020 undergoing therapy in department of endocrinology in 4Chong Qing hospitals.According to the latest American Diabetes Association(ADA)guidelines,260 patients were diagnosed with DKA,15patients were diagnosed with HHS,and 34 patients had both DKA and HHS characteristics.According to the recommendation in the Joint British Diabetes Societies for Inpatient Care guideline,169 patients were diagnosed with DKA,37 patients were diagnosed with HHS,and 43patients had both DKA and HHS characteristics.We recorded the patients’general information,laboratory indicators,and followed up their prognosis and survival outcome for 3 years.Finally,We collate the collected these data,and use SPSS26.0 software for statistical analysis,we sum up the clinical characteristics and clinical outcomes of these patients diagnosed by different guidelines,and explore the relationship between general conditions,basic diseases,important laboratory indicators and their treatment outcome and long-term prognosis of patients with HCE.Results:Most patients with HCE were complicated with infection.The same time,infection was the most common direct cause of HCE.In addition,new diagnosis of diabetes mellitu and poor adherence to treatment were also common in HCE.Among DKA cases,the average age of patients according to ADA guideline was older,and with a higher proportion of complicated chronic cardiovascular disease and chronic renal insufficiency,than the patiens diagnosed according to the Joint British Diabetes Societies for Inpatient Care guideline,while the latter had a lower concentration of Cl~-,more severe acidosis,and a higher proportion of complicated chronic cerebrovascular disease(all P<0.05).DKA and Combined DKA-HHS patients according to ADA guideline with higher in-hospital mortality,3-year mortality,and incidence of adverse outcomes compared with the patients diagnosed according to the British guideline;HHS patients according to ADA guideline with lower in-hospital mortality,3-year mortality,and incidence of adverse outcomes compared with the patients diagnosed according to the British guideline.However,these difference was not statistically significant.Isolated HHS or combined DKA-HHS is associated with higher mortality compared with isolated DKA.Although the treatment of HCE is effective,there is a high risk of recurrence,a lifelong dialysis and even death within 3 years.We found that age,Glu,osmolality,Na~+,K~+,Blood Urea Nitrogen(BUN),C-Reactive Protein(CRP),and chronic cerebrovascular disease were all positively correlated with the risk of death and adverse outcomes;in addition,chronic cardiovascular disease was associated with an increased risk of adverse outcomes;high Serum Creatinine(SCr)level,combined infection,and chronic metabolic disease were associated with high 3-year mortality;After accounting for multiple factors,age and BUN still showed a significant association with 3-year mortality and adverse outcomesin patients with HCE according to ADA guideline.In patients with HCE diagnosed according to the British guideline,age,Glu,osmolality,BUN,chronic cerebrovascular and cardiovascular disease were all positively correlated with the risk of death and adverse outcomes;in addition,high Na~+and SCr level,combined infection were associated with high 3-year mortality;After accounting for multiple factors,age still showed a significant association with 3-year mortality.Conclusion:DKA patients diagnosed by ADA guidelines are older and have a higher risk of adverse outcomes.The length of hospital stay,co-infection,underlying comorbidities,and high level of Glu and osmolality,SCR,CRP,and serum electrolytes may are associated with higher on the mortality and poor prognosis of patients with HCE.Age and BUN level are two independent mortality and poor prognosis predictors for patients with HCE.