title: Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study.
abstract: Hyperglycemic crisis episodes (HCEs)-diabetic ketoacidosis and the hyperosmolar hyperglycemic state-are the most serious acute metabolic complications of diabetes. We aimed to investigate the subsequent mortality after HCE in the non-elderly diabetic which is still unclear. This retrospective national population-based cohort study reviewed, in Taiwan's National Health Insurance Research Database, data from 23,079 non-elder patients (≤65 years) with new-onset diabetes between 2000 and 2002: 7693 patients with HCE and 15,386 patients without HCE (1:2). Both groups were compared, and follow-up prognoses were done until 2011. One thousand eighty-five (14.1%) patients with HCE and 725 (4.71%) patients without HCE died (P < 0.0001) during follow-up. Incidence rate ratios (IRR) of mortality were 3.24 times higher in patients with HCE than in patients without HCE (P < 0.0001). Individual analysis of diabetic ketoacidosis and hyperosmolar hyperglycemic state also showed the similar result with combination of both. After stratification by age, mortality was significant higher in the middle age (40-64 years) [IRR 3.29; 95% confidence interval (CI) 2.98-3.64] and young adult (18-39 years) (IRR 3.91; 95% CI 3.28-4.66), but not in the pediatric subgroup (<18 years) (IRR 1.28; 95% CI 0.21-7.64). The mortality risk was highest in the first month (IRR 54.43; 95% CI 27.98-105.89), and still high after 8 years (IRR 2.05; 95% CI 1.55-2.71). After adjusting for age, gender, and selected comorbidities, the mortality hazard ratio for patients with HCE was still four times higher than for patients without HCE. Moreover, older age, male gender, stroke, cancer, chronic obstructive pulmonary disease, congestive heart failure, and liver disease were independent mortality predictors. HCE significantly increases the subsequent mortality risk in the non-elderly with diabetes. Strategies for prevention and control of comorbidities are needed as soon as possible.
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Kao
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.|Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Chien-Chin
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.|Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.|Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Shih-Bin
authors.initials: SB
authors.lastname: Su
authors.affiliation: Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. chienchenghuang@yahoo.com.tw.|Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan. chienchenghuang@yahoo.com.tw.|Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan City, 701, Taiwan. chienchenghuang@yahoo.com.tw.|Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan. chienchenghuang@yahoo.com.tw.|Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan. chienchenghuang@yahoo.com.tw.
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan City, 701, Taiwan. hrguo@mail.ncku.edu.tw.|Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. hrguo@mail.ncku.edu.tw.
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000401:mortality*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000401:mortality*; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Diabetes; Hyperglycemic crisis; Middle age; Mortality; Non-elderly; Pediatric; Young adult