Abstract：
OBJECTIVE: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the intensive care unit each year, with mortality rates up to 5-10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality.
METHODS: We conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 to 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by International Classification of Disease-9-CM and International Classification of Disease-10-CM codes for psychiatric diagnoses that were present in patients electronic medical record at any point in this observational period. Outcomes included the number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and end-stage renal disease/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at P < 0.05.
RESULTS: Seven thousand seven hundred fifty-six patients were admitted for DKA or HHS, 66.9% of whom had a concurrent psychiatric disorder. Of these patients, 54.5% were male, 70.4% were White, and they had an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of whom were male, 72.1% were White, and an average age of 68.2 years. A concurrent psychiatric disorder was associated with increased odds of rehospitalization (adjusted odds ratio [aOR] = 1.62 95% confidence interval [CI] 1.35-1.95, P < 0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% CI 1.002-1.035, P = 0.02), and of leaving AMA (aOR = 6.44 95% CI 4.46-9.63, P < 0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of -7.5 years (95% CI -9.3 to 5.8) compared to those without a psychiatric disorder.
CONCLUSIONS: Of patients with DKA/HHS, 66.9% have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and to have a lower age of mortality.
METHODS: We conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 to 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by International Classification of Disease-9-CM and International Classification of Disease-10-CM codes for psychiatric diagnoses that were present in patients electronic medical record at any point in this observational period. Outcomes included the number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and end-stage renal disease/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at P < 0.05.
RESULTS: Seven thousand seven hundred fifty-six patients were admitted for DKA or HHS, 66.9% of whom had a concurrent psychiatric disorder. Of these patients, 54.5% were male, 70.4% were White, and they had an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of whom were male, 72.1% were White, and an average age of 68.2 years. A concurrent psychiatric disorder was associated with increased odds of rehospitalization (adjusted odds ratio [aOR] = 1.62 95% confidence interval [CI] 1.35-1.95, P < 0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% CI 1.002-1.035, P = 0.02), and of leaving AMA (aOR = 6.44 95% CI 4.46-9.63, P < 0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of -7.5 years (95% CI -9.3 to 5.8) compared to those without a psychiatric disorder.
CONCLUSIONS: Of patients with DKA/HHS, 66.9% have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and to have a lower age of mortality.
摘要：
背景：糖尿病酮症酸中毒（DKA）和高渗性高血糖状态（HHS）是危及生命的疾病，每年将近18万名患者送入ICU，死亡率高达5-10%。关于并发精神疾病对特定DKA/HHS结局的影响知之甚少。识别这些关系提供了改善临床管理的机会，治疗计划,并减轻相关的发病率和死亡率。
方法：我们进行了回顾性研究，包括2010年至2019年马萨诸塞州一家大型医院系统内的成人DKA/HHS入院。我们确定了因DKA或HHS住院的患者，然后通过ICD-9-CM过滤，ICD-10-CM编码了在此观察期内任何时间点EMR患者中存在的精神病诊断。结果包括DKA/HHS住院人数，死亡年龄,任何住院患者的医疗建议(AMA)出院率，和ESRD/透析状态。使用R软件进行多变量回归，以控制患者之间的变量，并评估结果与并发精神疾病之间的关系。显著性设定为p<0.05。
结果：7756例患者因DKA或HHS入院，其中66.9％患有并发精神障碍。这些患者中54.5%为男性，70.4%白色,平均年龄为61.6岁。相比之下，一般糖尿病人群中并发精神病的比例为26.1%，其中52.1%为男性，72.1%白色,平均68.2年。并发精神障碍与再住院几率增加相关(aOR=1.6295%Cl1.35-1.95,p<0.001),被诊断为终末期肾病和透析（aOR=1.0295％Cl1.002-1.035，p=0.02），和离开AMA(aOR=6.4495%Cl4.46-9.63，p<0.001)。与没有精神疾病的人相比，患有并发精神疾病的人的平均死亡年龄在-7.5年（95％Cl-9.35.8）的调整后平均差。
结论：66.9%的DKA/HHS患者并发精神障碍。因DKA/HHS入院的并发精神疾病患者更有可能多次入院，离开AMA,接受肾透析,并且死亡率较低。
方法：我们进行了回顾性研究，包括2010年至2019年马萨诸塞州一家大型医院系统内的成人DKA/HHS入院。我们确定了因DKA或HHS住院的患者，然后通过ICD-9-CM过滤，ICD-10-CM编码了在此观察期内任何时间点EMR患者中存在的精神病诊断。结果包括DKA/HHS住院人数，死亡年龄,任何住院患者的医疗建议(AMA)出院率，和ESRD/透析状态。使用R软件进行多变量回归，以控制患者之间的变量，并评估结果与并发精神疾病之间的关系。显著性设定为p<0.05。
结果：7756例患者因DKA或HHS入院，其中66.9％患有并发精神障碍。这些患者中54.5%为男性，70.4%白色,平均年龄为61.6岁。相比之下，一般糖尿病人群中并发精神病的比例为26.1%，其中52.1%为男性，72.1%白色,平均68.2年。并发精神障碍与再住院几率增加相关(aOR=1.6295%Cl1.35-1.95,p<0.001),被诊断为终末期肾病和透析（aOR=1.0295％Cl1.002-1.035，p=0.02），和离开AMA(aOR=6.4495%Cl4.46-9.63，p<0.001)。与没有精神疾病的人相比，患有并发精神疾病的人的平均死亡年龄在-7.5年（95％Cl-9.35.8）的调整后平均差。
结论：66.9%的DKA/HHS患者并发精神障碍。因DKA/HHS入院的并发精神疾病患者更有可能多次入院，离开AMA,接受肾透析,并且死亡率较低。
