Predictors of length of hospital stay in patients presenting to the emergency department with hyperosmolar hyperglycemic crises.

OBJECTIVE

To predict the length of hospital stay in hyperosmolar hyperglycemic crises (HHC) using variables available on admission.

METHODS

We conducted a retrospective cohort study with 132 patients (65 [49.2%] men; median age 72 years; range 19-98 years) hospitalized for HHC (including hyperosmolar hyperglycemic state and diabetic ketoacidosis with elevated osmolality) in a Spanish teaching hospital. Baseline variables and those upon arrival to the emergency department were collected (both variables related to physical examination and biochemical tests), as well as the in-hospital mortality rate and overall length of hospital stay in survivors.

RESULTS

Patients who died (n=13) had higher total serum osmolality and higher C-reactive protein concentrations on admission vs survivors. Among survivors, the length of stay correlated positively with total serum osmolality (Rho=0.398; p<0.001) and C-reactive protein (Rho=0.342; p<0.001) on admission. Older age, female sex, lack of pre-admission diagnosis of insulin-requiring diabetes, impaired mental status on arrival, non-ketotic metabolic acidosis, and low serum potassium concentrations were also associated with long lengths of stay. In multivariate analysis, only serum glucose (one of the three components of total osmolality) and C-reactive protein concentrations on admission kept a positive association with the length of stay.

CONCLUSIONS

Hyperglycemia and elevated C-reactive protein on admission are independent predictors of long lengths of stay in survivors with HHC.