title: Predictors of hyperglycaemic crises and their associated mortality in Jamaica.
abstract: The objective of the study was to determine the clinical characteristics and mortality of patients with hyperglycaemic hyperosmolar syndrome (HHS) and diabetic ketoacidosis (DKA) at a Jamaican tertiary care hospital. In a retrospective study of 1560 admissions for diabetes during the period 1998-2002, 980 dockets were reviewed and 164 individuals met the ADA diagnostic criteria for DKA or HHS. Patients with HHS were older than DKA patients (64.5 years [95% CI: 60.7-68.4] versus 35.9 years [95% CI: 30.2-41.6]), but were not more likely to be non-compliant with medications, infected, or male. Overall, 24% had a mixed DKA/HHS syndrome. Most DKA patients had type 2 diabetes (62%). Only 2% of HHS and 6% of DKA/HHS patients had type 1 diabetes. Syndrome specific mortality was: DKA 6.7%, HHS 20.3%, and DKA/HHS 25% (p for trend=0.013). Mortality increased significantly with age, especially in patients > or =50 years. Significant univariate predictors of mortality were altered mental status on admission, co-existing medical disease, increasing age, older age at onset of diabetes, acute stressors, and DKA/HHS. In multivariate models, only altered mental status was significant (OR=3.59; 95% CI: 1.24-10.41). Hence, hyperglycaemic crises in a Jamaican tertiary care hospital are associated with significant mortality especially in patients who are older or with altered mental status.
authors.affiliation: Tropical Medicine Research Institute, University of West Indies, Mona, Jamaica.
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Chung
authors.forename: Gillian Gordon
authors.initials: GG
authors.lastname: Perue
authors.forename: Ayesha
authors.initials: A
authors.lastname: Johnson
authors.forename: Novie
authors.initials: N
authors.lastname: Younger
authors.forename: Carla S
authors.initials: CS
authors.lastname: Hoo
authors.forename: Rosemarie Wright
authors.initials: RW
authors.lastname: Pascoe
authors.forename: Michael S
authors.initials: MS
authors.lastname: Boyne
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000175:diagnosis* / Q000401:mortality*; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013577:Syndrome