• Hua-Fen Chen, Chih-Yuan Wang, Hsin-Yu Lee, Ting-Ting See, Mei-Hsiu Chen, Ju-Ying Jiang, Ming-Tsang Lee, and Chung-Yi Li.
• Department of Endocrinology, Far-Eastern Memorial Hospital, Taipei Hsien, Taiwan.
• Intern. Med. 2010 Jan 1;49(8):729-37.

Background And PurposeDiabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. Our aim was to evaluate the 28-day case-fatality rate among hospitalized DKA and HHS patients in a teaching hospital in Taiwan from 1991 to 2005.MethodsDKA and HHS admissions, identified from in-patient electronic database, were linked to Taiwan's national death registry. Kaplan-Meier analysis was used to determine the 28-day case-fatality rates of DKA and HHS, and to compare the trend of case-fatality over three consecutive 5-year periods (i.e, 1991-1995, 1996-2000, 2001-2005). We also used the Cox proportional hazard regression model to explore the determinants of 28-day case-fatality of the study patients.ResultsThe 28-day case-fatality rates for DKA and HHS were 6.10% and 18.83%, and the lowest ones were observed in 2001-2005 (2.65% and 11.63% in DKA and HHS, respectively). Pneumonia was a significant predictor for increased 28-day case-fatality in both illnesses. Additionally, older age and stroke were significantly associated with increased case-fatality in DKA patients while myocardial infarction and higher Charlson index were significant predictors for higher case-fatality in HHS patients.ConclusionImprovements in case-fatality in recent years for both DKA and HHS were found in the study hospital. Further reduction of the case-fatality rate among DKA and HHS patients can be achieved by optimal management of certain co-morbidities.

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