根据全国数据集，入院的糖尿病酮症酸中毒和高钠血症患者的临床结果

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.087

Mohammad Amin Eshghabadi MD, ReyhanehSadat Rahimi MD, Sila Mateo Faxas MD, Gregory Pierce BS, Brenda Pierce MD, Natalie Assaf BA, Michael Fatuyi MD, Borna Mansouri MD, Jason Pichardo MD, Fayaz Khan MD, Mohammed Najdat Seijari MD, Muayad Alzamara MD, Shahla Mallick MD, M Kenan Rahima MD, Mian Hammas MD

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引用次数: 0

摘要

背景/简介糖尿病酮症酸中毒（DKA）和高钠血症之间的关联强调了代谢紊乱的复杂相互作用。DKA以胰岛素缺乏为特征，诱发高血糖和渗透性利尿，可能导致脱水和高钠血症。目的/目的关于DKA合并高钠血症患者预后的科学证据有限。方法利用2017-2020年全国住院患者样本，对住院的DKA和高钠血症患者进行识别。主要终点：住院病人死亡率；次要终点：心源性休克、心脏骤停、插管率、住院时间和医院总收费。采用多种因素校正后的多变量logistic回归分析。结果在1,239,020例DKA住院患者中，6.9% （n = 85,999）发生高钠血症。高钠血症患者年龄稍大（平均55.7岁对45.1岁），男性和白种人居多（54.1%对50.7%，46.8%对55.7%）。而两组之间的共病患病率相似(肥胖、COPD、血脂异常、AFib、HTN、PVD、既往CVA、尼古丁使用；EtOH使用)。高钠血症与显著较差的结局相关：更高的死亡率（10.2% vs. 2.6%, OR 1.9）、心源性休克发生率增加（2.1% vs. 0.8%, OR 1.7）、心脏骤停（4.4% vs. 1.2%, OR 2.2）、插管（24.7% vs. 4.7%, OR 4.3）、更长的LOS （10.3 vs. 4.5天，IRR 1.67）和更高的费用（32,702.86美元vs. 12,869.73美元，IRR 1.77）。所有结果均有统计学意义(p <；0.01)，并根据各种因素进行了调整。结论：虽然合并症相似，但高钠血症组的结果更差，包括更高的死亡率、不良事件、延长的住院时间和更高的资源利用率。临床医生应该认识到高钠血症是DKA管理中的一个负面预后因素，需要有针对性的干预措施来减轻不良后果。

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Clinical outcomes in patients admitted with diabetic ketoacidosis & hypernatremia, according to a nation-wide dataset

Background/Synopsis

The association between diabetic ketoacidosis (DKA) and hypernatremia underscores a complex interplay of metabolic derangement. DKA, characterized by insulin deficiency, induces hyperglycemia and osmotic diuresis, potentially leading to dehydration and hypernatremia.

Objective/Purpose

There's limited scientific evidence examining outcomes among patients presenting with DKA and hypernatremia.

Methods

We utilized the National Inpatient Sample from 2017-2020 to identify patients admitted with DKA and hypernatremia. Primary endpoints: inpatient mortality; secondary endpoints: cardiogenic shock, cardiac arrest, intubation rate, length of stay, and total hospital charges. Multivariable logistic regression analysis adjusted for various factors was employed.

Results

Among 1,239,020 DKA hospitalizations, 6.9% (n = 85,999) had hypernatremia. Hypernatremia patients were slightly older (mean 55.7 vs. 45.1 years), male and Caucasian predominance (54.1% vs. 50.7% and 46.8% vs. 55.7%). While comorbidity prevalence was similar between groups (Obesity, COPD, Dyslipidemia, AFib, HTN, PVD, prior CVA, nicotine use & EtOH use). Hypernatremia was associated with significantly worse outcomes: higher mortality (10.2% vs. 2.6%, OR 1.9), increased rates of cardiogenic shock (2.1% vs. 0.8%, OR 1.7), cardiac arrest (4.4% vs. 1.2%, OR 2.2), intubation (24.7% vs. 4.7%, OR 4.3), longer LOS (10.3 vs. 4.5 days, IRR 1.67), and higher cost ($32,702.86 vs. $12,869.73, IRR 1.77). All results were statistically significant (p < 0.01) and adjusted for various factors.

Conclusions

Although comorbidity profiles were similar, the hypernatremia group had worse outcomes, including higher mortality, adverse events, prolonged hospital stays, and increased resource utilization. Clinicians should recognize hypernatremia as a negative prognostic factor in DKA management, necessitating tailored interventions to mitigate adverse outcomes.

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.