Prognostic Factors for the Hyperosmolar Nonketotic State

ABSTRACT

BACKGROUND: A hyperosmolar nonketotic state has been known to have a high mortality, and even now, despite this high mortality, only a few studies of this disease have been performed. We studied the prognostic factors for the hyperosmolar nonketotic state. METHODS: We retrospectively studied the cases of 40 patients who were in a hypersomolar nonketotic state when admitted to Sanggye Paik Hospital during the 6-year period from 1995 through 2000. We divided the hyperosmolar nonketotic patients into two groups, the complete recovery group and the incomplete recovery group, and compared the clinical features, the laboratory findings, and the precipitating factors between two groups. RESULTS: 1) A total of 40 patients were studied 24 in the complete recovery group and 16 patients in the incomplete recovery group. The mortality rate was 32.5%. 2) No significant statistical difference existed among the clinical features of the two groups, except for the sex(p<0.01). 3) Among the laboratory findings of both groups, analysis revealed that the effective osmolarity was significantly higher among those in the incomplete recovery group(p<0.01). Serum sodium concentration was also significantly higher among those in the incomplete recovery group(p<0.01). Serum creatinine was also significantly higher among those in the incomplete recovery group(p<0.05). Serum bicarbonate concentration, on the other hand, was significantly lower among those in that group(p<0.05). 4) Infection was identified as the most common precipitating factor(62.5%). Among the precipitating factors of the two groups, there were significant statistical difference in pneumonia, UTI, and inappropriate glucose control. 5) A significant statistical difference existed among the initial level of onsciousness of both groups(p<0.05). 6) The only significant independent factor responsible for prognosis of nonketotic hyperosmolar state patients was the sex. CONCLUSION: The sex was only significant independent prognostic factor of nonketotic hyperosmolar state patients.