Predictors of length of hospital stay in patients presenting to the emergency department with hyperosmolar hyperglycemic crises

4区医学 Q3 Nursing

Endocrinologia, Diabetes y Nutricion Pub Date : 2025-06-01 DOI:10.1016/j.endinu.2025.501577

Tomás González-Vidal , Diego Rivas-Otero , Carmen Lambert , Jessica Ares Blanco , Elías Delgado-Álvarez , Edelmiro Menéndez Torre

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Abstract

Objective

To predict the length of hospital stay in hyperosmolar hyperglycemic crises (HHC) using variables available on admission.

Methods

We conducted a retrospective cohort study with 132 patients (65 [49.2%] men; median age 72 years; range 19–98 years) hospitalized for HHC (including hyperosmolar hyperglycemic state and diabetic ketoacidosis with elevated osmolality) in a Spanish teaching hospital. Baseline variables and those upon arrival to the emergency department were collected (both variables related to physical examination and biochemical tests), as well as the in-hospital mortality rate and overall length of hospital stay in survivors.

Results

Patients who died (n = 13) had higher total serum osmolality and higher C-reactive protein concentrations on admission vs survivors. Among survivors, the length of stay correlated positively with total serum osmolality (Rho = 0.398; p < 0.001) and C-reactive protein (Rho = 0.342; p < 0.001) on admission. Older age, female sex, lack of pre-admission diagnosis of insulin-requiring diabetes, impaired mental status on arrival, non-ketotic metabolic acidosis, and low serum potassium concentrations were also associated with long lengths of stay. In multivariate analysis, only serum glucose (one of the three components of total osmolality) and C-reactive protein concentrations on admission kept a positive association with the length of stay.

Conclusions

Hyperglycemia and elevated C-reactive protein on admission are independent predictors of long lengths of stay in survivors with HHC.

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急诊高渗性高血糖危象患者住院时间的预测因素

目的利用入院时可用的变量预测高渗性高血糖危像（HHC）的住院时间。方法对132例患者进行回顾性队列研究，其中65例（49.2%）男性；中位年龄72岁；年龄19-98岁)在西班牙一家教学医院因HHC（包括高渗性高血糖状态和糖尿病酮症酸中毒伴高渗）住院。收集基线变量和到达急诊科时的变量（这两个变量都与体格检查和生化测试有关），以及幸存者的住院死亡率和总住院时间。结果死亡患者（n = 13）入院时总血清渗透压和c反应蛋白浓度高于幸存者。在幸存者中，住院时间与血清总渗透压呈正相关(Rho = 0.398；p & lt;0.001)和c反应蛋白(Rho = 0.342；p & lt;0.001)。年龄较大、女性、入院前未诊断出需要胰岛素的糖尿病、入院时精神状态受损、非酮症代谢性酸中毒和血清钾浓度低也与住院时间过长有关。在多变量分析中，只有入院时的血清葡萄糖（总渗透压的三个组成部分之一）和c反应蛋白浓度与住院时间呈正相关。结论入院时高血糖和c反应蛋白升高是HHC存活患者住院时间的独立预测因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrinologia, Diabetes y Nutricion Nursing-Nutrition and Dietetics

CiteScore

2.10

自引率

0.00%

发文量

169

审稿时长

35 days

期刊介绍： Endocrinología, Diabetes y Nutrición is the official journal of the Spanish Society of Endocrinology and Nutrition (Sociedad Española de Endocrinología y Nutrición, SEEN) and the Spanish Society of Diabetes (Sociedad Española de Diabetes, SED), and was founded in 1954. The aim of the journal is to improve knowledge and be a useful tool in practice for clinical and laboratory specialists, trainee physicians, researchers, and nurses interested in endocrinology, diabetes, nutrition and related disciplines. It is an international journal published in Spanish (print and online) and English (online), covering different fields of endocrinology and metabolism, including diabetes, obesity, and nutrition disorders, as well as the most relevant research produced mainly in Spanish language territories. The quality of the contents is ensured by a prestigious national and international board, and by a selected panel of specialists involved in a rigorous peer review. The result is that only manuscripts containing high quality research and with utmost interest for clinicians and professionals related in the field are published. The Journal publishes Original clinical and research articles, Reviews, Special articles, Clinical Guidelines, Position Statements from both societies and Letters to the editor. Endocrinología, Diabetes y Nutrición can be found at Science Citation Index Expanded, Medline/PubMed and SCOPUS.