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In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample
Background: In patients hospitalized with Hyperosmolar hyperglycemic state (HHS) the presence of comorbid conditions including hypertension, heart disease, stroke, and dementia have been variably reported to be associated with higher mortality. HTG is increasingly prevalent in patients with DM, espe...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089613/ http://dx.doi.org/10.1210/jendso/bvab048.869 |
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author | Velazquez, Genaro Shaka, Hafeez Murthi, Mukunthan Asemota, Iriagbonse Velagapudi, Sujitha Marcos-Abdala, Hernan Gerardo Akuna, Emmanuel Edigin, Ehizogie |
author_facet | Velazquez, Genaro Shaka, Hafeez Murthi, Mukunthan Asemota, Iriagbonse Velagapudi, Sujitha Marcos-Abdala, Hernan Gerardo Akuna, Emmanuel Edigin, Ehizogie |
author_sort | Velazquez, Genaro |
collection | PubMed |
description | Background: In patients hospitalized with Hyperosmolar hyperglycemic state (HHS) the presence of comorbid conditions including hypertension, heart disease, stroke, and dementia have been variably reported to be associated with higher mortality. HTG is increasingly prevalent in patients with DM, especially those with poor glycemic control who are more likely to suffer from HHS. Elevated triglyceride levels have independently been associated with higher mortality in certain conditions like coronary artery disease and acute pancreatitis. However, data on the effect of Hypertriglyceridemia (HTG) on mortality and morbidity in hospitalized patients with HHS is sparse. Objective: We wanted to compare the outcomes for HHS hospitalizations for patients with and without HTG. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of HTG as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders. Results: Out of the 42 740 hospitalizations with HHS, about 17 040 had HTG. The in-hospital mortality for patients with HHS was 305 overall, out of which 70 patients had HTG as secondary diagnosis. Compared with patients without HTG, patients with HTG had lower odds of in- hospital mortality (0.30, 95% CI 0.157–0.56, p<0.005) when adjusted for patient and hospital characteristics. Patients with HHS and HTG had decreased length of hospital stay, less total Hospital charges, lower odds of Sepsis and Septic Shock, but similar odds of AKI and ARF in comparison to patients without HTG. Conclusion: Our study shows that HTG is associated with lower odds of in-hospital mortality in patients with HHS, even though the odds of AKI and ARF was same in both groups. A similar inverse relationship has already been reported between TG levels and mortality in stroke patients. Though the mechanism of this effect is unclear, one possible explanation could be that patients with HTG are more likely to be treated with statins and fibrates which have known anti-inflammatory effects. Further studies are required to evaluate this possible positive prognostic effect of TG. |
format | Online Article Text |
id | pubmed-8089613 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-80896132021-05-06 In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample Velazquez, Genaro Shaka, Hafeez Murthi, Mukunthan Asemota, Iriagbonse Velagapudi, Sujitha Marcos-Abdala, Hernan Gerardo Akuna, Emmanuel Edigin, Ehizogie J Endocr Soc Diabetes Mellitus and Glucose Metabolism Background: In patients hospitalized with Hyperosmolar hyperglycemic state (HHS) the presence of comorbid conditions including hypertension, heart disease, stroke, and dementia have been variably reported to be associated with higher mortality. HTG is increasingly prevalent in patients with DM, especially those with poor glycemic control who are more likely to suffer from HHS. Elevated triglyceride levels have independently been associated with higher mortality in certain conditions like coronary artery disease and acute pancreatitis. However, data on the effect of Hypertriglyceridemia (HTG) on mortality and morbidity in hospitalized patients with HHS is sparse. Objective: We wanted to compare the outcomes for HHS hospitalizations for patients with and without HTG. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of HTG as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders. Results: Out of the 42 740 hospitalizations with HHS, about 17 040 had HTG. The in-hospital mortality for patients with HHS was 305 overall, out of which 70 patients had HTG as secondary diagnosis. Compared with patients without HTG, patients with HTG had lower odds of in- hospital mortality (0.30, 95% CI 0.157–0.56, p<0.005) when adjusted for patient and hospital characteristics. Patients with HHS and HTG had decreased length of hospital stay, less total Hospital charges, lower odds of Sepsis and Septic Shock, but similar odds of AKI and ARF in comparison to patients without HTG. Conclusion: Our study shows that HTG is associated with lower odds of in-hospital mortality in patients with HHS, even though the odds of AKI and ARF was same in both groups. A similar inverse relationship has already been reported between TG levels and mortality in stroke patients. Though the mechanism of this effect is unclear, one possible explanation could be that patients with HTG are more likely to be treated with statins and fibrates which have known anti-inflammatory effects. Further studies are required to evaluate this possible positive prognostic effect of TG. Oxford University Press 2021-05-03 /pmc/articles/PMC8089613/ http://dx.doi.org/10.1210/jendso/bvab048.869 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Diabetes Mellitus and Glucose Metabolism Velazquez, Genaro Shaka, Hafeez Murthi, Mukunthan Asemota, Iriagbonse Velagapudi, Sujitha Marcos-Abdala, Hernan Gerardo Akuna, Emmanuel Edigin, Ehizogie In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample |
title | In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample |
title_full | In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample |
title_fullStr | In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample |
title_full_unstemmed | In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample |
title_short | In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample |
title_sort | in-hospital outcomes in patients with hyperosmolar hyperglycemic state with and without hypertriglyceridemia: analysis of national inpatient sample |
topic | Diabetes Mellitus and Glucose Metabolism |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089613/ http://dx.doi.org/10.1210/jendso/bvab048.869 |
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