Predicting readmission due to severe hyperglycemia after a hyperglycemic crisis episode

Wei-Tsen Liao; Chun-Chuan Lee; Chih-Lin Kuo; Kuan-Chia Lin

doi:10.1016/j.diabres.2022.110115

Predicting readmission due to severe hyperglycemia after a hyperglycemic crisis episode

Diabetes Res Clin Pract. 2022 Oct:192:110115. doi: 10.1016/j.diabres.2022.110115. Epub 2022 Oct 8.

Authors

Wei-Tsen Liao¹, Chun-Chuan Lee², Chih-Lin Kuo³, Kuan-Chia Lin⁴

Affiliations

¹ Division of Endocrinology & Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, 92, Sec. 2, Zhongshan N. Rd, Zhongshan Dist., Taipei City 10449, Taiwan, ROC; Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd, Sanzhi Dist, New Taipei City 25245, Taiwan, ROC; Community Medicine Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Beitou District, Taipei City 11221, Taiwan, ROC.
² Division of Endocrinology & Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, 92, Sec. 2, Zhongshan N. Rd, Zhongshan Dist., Taipei City 10449, Taiwan, ROC; Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd, Sanzhi Dist, New Taipei City 25245, Taiwan, ROC.
³ Community Medicine Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Beitou District, Taipei City 11221, Taiwan, ROC; Yong Cheng Rehabilitation Clinic, Taipei City 10663, Taiwan, ROC.
⁴ Community Medicine Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Beitou District, Taipei City 11221, Taiwan, ROC; Cheng Hsin General Hospital, Taipei, Taiwan, ROC. Electronic address: kuanchia@nycu.edu.tw.

PMID: 36220515
DOI: 10.1016/j.diabres.2022.110115

Abstract

Aim: This study aimed to investigate the readmission pattern and risk factors for patients who experienced a hyperglycemic crisis.

Methods: Patients admitted to MacKay Memorial Hospital for diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) between January 2016 and April 2019 were studied. The timing of the first readmission for hyperglycemia and other causes was recorded. Kaplan-Meier analysis was used to compare patients with hyperglycemia and all-cause readmissions. Cox regression was used to identify independent predictors for hyperglycemia and all-cause readmission post-discharge.

Results: The study cohort included 410 patients, and 15.3 % and 46.3 % of them had hyperglycemia and all-cause readmissions, respectively. The DKA and HHS group showed a similar incidence for hyperglycemia, with the latter group showing a higher incidence of all-cause readmissions. The significant predictors of hyperglycemia readmissions included young age, smoking, hypoglycemia, higher effective osmolality, and hyperthyroidism in the DKA group and higher glycated hemoglobin level in the HHS group.

Conclusions: Patients who experienced DKA and HHS had similar hyperglycemia readmission rates; however, predictors in the DKA group were not applicable to the HHS group. Designing different strategies for different types of hyperglycemic crisis is necessary for preventing readmission.

Keywords: Diabetic ketoacidosis; Hyperglycemic crisis; Hyperglycemic hyperosmolar state; Readmission.

MeSH terms

Aftercare
Diabetic Ketoacidosis* / complications
Diabetic Ketoacidosis* / etiology
Humans
Hyperglycemia* / complications
Hyperglycemia* / etiology
Hyperglycemic Hyperosmolar Nonketotic Coma* / epidemiology
Hyperglycemic Hyperosmolar Nonketotic Coma* / etiology
Patient Discharge
Patient Readmission