(18.01) Impact of hypertension on hyperosmolar hyperglycemic state outcomes: a nationwide inpatient sample analysis

Hyperosmolar hyperglycemic state (HHS), or Hyperosmotic hyperglycemic nonketotic state (HHNK), is a serious complication associated with type 2 diabetes mellitus. It accounts for < 1 percent of diabetic hospital admissions. Mortality rates can vary anywhere between 10 and 20%. There is limited research performed to study the presence of hypertension on HHS outcomes. Therefore, we aimed to study the impact of hypertension in patients with HHS.

Methods:

This retrospective study used a Nationwide Inpatient Sample 2020 (NIS) using the International Classification of Diseases (ICD-10) codes for HHS. STATA version MP14.2 was used mainly for analysis. We used Fischer's exact test to compare proportions, the student's t-test to compare continuous variables, and multivariate regression analysis to calculate the adjusted odds ratio(aOR). The primary outcome of the study was mortality, and secondary outcomes were length of stay (LOS), total charges, acute kidney injury (AKI), dialysis rate, intubation rate, severe sepsis with septic shock, cerebral edema, noncardiogenic pulmonary edema, hypovolemic shock, severe sepsis without septic shock, vasopressor use, cerebrovascular accident, myocardial infarction, acute pancreatitis, and urinary tract infection.

Results:

Among 32,355,827 total discharges, the total number of patients >18 years with a diagnosis of HHS was 46,235; out of them, 17,445 (37.73%) had a diagnosis of hypertension. Patients with hypertension had lower rates of mortality (aOR=0.71, 2.89% vs. 5.09%, p=0.024), mean LOS (adjusted mean difference: -1.13, 4.85% vs. 6.62%, p< 0.01), and total charges (adjusted mean difference=$-12,235, $55837 vs. $77982, p< 0.01). Other significant outcomes were lower rates of AKI (aOR: 0.73, 51.76% vs.62.04%, p< 0.01, dialysis rate (aOR: 0.2, 0.83% vs. 7.4%, p< 0.01), intubation rates (aOR: 0.58, 5% vs.9%, p< 0.01, and severe sepsis with septic shock (aOR: 0.5, 3.61% vs.7.67%, p< 0.01) in patients with hypertension compared to patients without hypertension.  There were no differences in the two groups in rates of cerebral edema, noncardiogenic pulmonary edema, hypovolemic shock, severe sepsis without septic shock, vasopressor use, cerebrovascular accident, myocardial infarction, acute pancreatitis, and urinary tract infection.

Discussion/Conclusion:

Hypertension is associated with lower rates of mortality, LOS, hospital charges, AKI, dialysis, intubation, and severe sepsis with septic shock in HHS patients.