title: Association between hyperglycaemic crisis and long-term major adverse cardiovascular events: a nationwide population-based, propensity score-matched, cohort study.
abstract: Hyperglycaemic crisis was associated with significant intrahospital morbidity and mortality. However, the association between hyperglycaemic crisis and long-term cardiovascular outcomes remained unknown. This study aimed to investigate the association between hyperglycaemic crisis and subsequent long-term major adverse cardiovascular events (MACEs).
  
  
  
  This population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database for the period of 1996-2012. A total of 2171 diabetic patients with hyperglycaemic crisis fit the inclusion criteria. Propensity score matching was used to match the baseline characteristics of the study cohort to construct a comparison cohort which comprised 8684 diabetic patients without hyperglycaemic crisis. The risk of long-term MACEs was compared between the two cohorts.
  
  
  
  Six hundred and seventy-six MACEs occurred in the study cohort and the event rate was higher than that in the comparison cohort (31.1% vs 24.1%, p<0.001). Patients with hyperglycaemic crisis were associated with a higher risk of long-term MACEs even after adjusting for all baseline characteristics and medications (adjusted HR=1.76, 95% CI 1.62 to 1.92, p<0.001). Acute myocardial infarction had the highest adjusted HR (adjusted HR=2.19, 95% CI 1.75 to 2.75, p<0.001) in the four types of MACEs, followed by congestive heart failure (adjusted HR=1.97, 95% CI 1.70 to 2.28, p<0.001). Younger patients with hyperglycaemic crisis had a higher risk of MACEs than older patients (adjusted HR=2.69 for patients aged 20-39 years vs adjusted HR=1.58 for patients aged >65 years).
  
  
  
  Hyperglycaemic crisis was significantly associated with long-term MACEs, especially in the young population. Further prospective longitudinal study should be conducted for validation.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Li-Hsin
authors.initials: LH
authors.lastname: Chang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Liang-Yu
authors.initials: LY
authors.lastname: Lin
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ming-Tsun
authors.initials: MT
authors.lastname: Tsai
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chorng-Kuang
authors.initials: CK
authors.lastname: How
authors.affiliation: Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan Management Office for Health Data, China Medical University, Taichung, Taiwan.
authors.forename: Jen-Huai
authors.initials: JH
authors.lastname: Chiang
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan.
authors.forename: Vivian Chia-Rong
authors.initials: VC
authors.lastname: Hsieh
authors.affiliation: Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan.
authors.forename: Sung-Yuan
authors.initials: SY
authors.lastname: Hu
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Ming-Shun
authors.initials: MS
authors.lastname: Hsieh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology* / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult
keywords: diabetic ketoacidosis; hyperglycemic crisis; hyperglycemic hyperosmolar status; major adverse cardiovascular event