Hiperglikemijske krize u bolesnika sa šećernom bolesti u Republici Hrvatskoj

Autor: Kruljac, Ivan
Přispěvatelé: Vrkljan, Milan, dostupno, nije
Jazyk: chorvatština
Rok vydání: 2023
Předmět:
Popis: Cilj. Glavni cilj istraživanja je odrediti incidenciju dijabetičke ketoze (DK) i ketoacidoze (DKA) u odraslih osoba na dobro definiranoj populaciji u Republici Hrvatskoj. Ostali ciljevi istraživanja su: otkriti antropometrijske i laboratorijske parametre koji su rizični čimbenici razvoja ketoze i DKA u ispitanika s ŠBT2; odrediti incidenciju dijabetičkog hiperosmolarnog sindroma (DHS) u ispitanika s ŠBT2; odrediti razlike u antropometrijskim i laboratorijskim parametrima između ispitanika s NKH, DK i DKA u ŠBT2; odrediti razlike u antropometrijskim i laboratorijskim parametrima između ispitanika s DKA u ŠBT2 i ŠBT1; odrediti smrtnost nakon pojedine hiperglikemijske krize i tragati za prognostičkim faktorima. Metode. Ispitivana populacija obuhvaćala je ukupno 261,749 odraslih osoba s područja Grada Zagreba i Zagrebačke županije. U studiju su uključeni svi bolesnici koji su u razdoblju od 1.1.2010. do 31.12.2014. pregledani u hitnoj internističkoj ambulanti uz vrijednost glukoze u plazmi > 13.9 mmol/L. Ovisno o nalazu acidobaznog statusa, ketonurije i osmolarnosti plazme su uvršteni u jednu od 4 skupine: neketotična hiperglikemija (NKH), DK, DKA ili DHS. Incidencija je izražena kao broj epizoda DK, DKA i DHS na 100,000 osoba-godina. Analiza smrtnosti je učinjena na svim bolesnicima s ŠBT2 u DHS, DKA i DK skupini, te u jednakog broja bolesnika u NKH skupini, identičnih prema dobi i spolu naspram DK skupine. Rezultati. Zabilježeno je 630 epizoda DK u 520 bolesnika, 215 epizoda DKA u 165 bolesnika i 68 epizoda DHS u 66 bolesnika. Samo 8.6% epizoda DK i 34.4% epizoda DKA zabilježeno je u bolesnika s ŠBT1, dok su preostali bolesnici imali ŠBT2. Standardizirani omjer incidencije je iznosio 48.1 (95% CI 44.5 - 52.1) za DK, 17.0 (95% CI 14.9 - 19.4) za DKA te 6.2 (95% CI 5.1 – 7.2) na DHS. Bolesnici s ŠBT1 i epizodom DK ili DKA su bili značajno mlađi i mršaviji, češće su imali novootkrivenu šećernu bolest, češće su pregledani u hitnoj službi zbog hiperglikemije i češće su bili hospitalizirani. Tijekom medijana praćenja od 33.4 mjeseca, smrtnost u NKH skupini iznosila je 40.9%, u DK skupini 30.2%, u DKA skupini 44.5% i 46.4% u DHS skupini. Smrtnost u DK skupini bila je značajno manja u odnosu na NKH skupinu (HR 0.63, 95% CI, 0.48 - 0.82; P = 0.0005). Smrtnost bolesnika s DKA je bila značajno veća naspram bolesnika s DK (HR 1.92, 95% CI 1.41 - 2.61, P
Aim. The main aim of this study was to estimate the incidence of diabetic ketosis (DK) and ketoacidosis (DKA) in a well defiend population in Croatia. Secondary aims were: to detect antropomenthric and laboratory parameters which could serve as predictors of DK and DKA; to estimate the incidence of diabetic hyperosmolar syndrome (DHS) in type 2 diabetes mellitus (ŠBT2); to analyze the differences in antropomethric and laboratory parameters between the NKH, DK and DKA groups; to analyze the differences in antropomethric and laboratory parameters between ŠBT1 and ŠBT2; to analyze mortality rates after each hyperglycemic crisis and to search for prognostic factors. Methods. Studied population comprised of 261,749 adults with a residency in City of Zagreb and Zagreb county. Patients admitted to emergency departement in the period between January 1st 2010 and December 31st 2014 with plasma glucose > 13.9 mmol/L were enrolled. Based on their acid-base analysis, urinary ketones and plasma osmolarity, they were classified into one of the following groups: non-ketotic hyperglycemia (NKH), DK, DKA or DHS. Incidence was expressed as the number of episodes per 100,000 person-years. Analysis of mortality was performed in all patients with ŠBT2 with DHS, DKA and DK, and in NKH patients who were age- and gender-matched with DK group in 1:1 fashion. Results. We observed 630 episodes of DK in 520 patients, 215 episodes of DKA in 165 patients and 68 episodes of DHS in 66 patients. Only 8.6% of DK episodes and 34.4% of DKA were attributed to ŠBT1, while all patients with DHS had ŠBT2. Stadardized incidence ratios were as follows: 48.1 (95% CI 44.5 - 52.1) for DK, 17.0 (95% CI 14.9 - 19.4) for DKA and 6.2 (95% CI 5.1 – 7.2) for DHS. Patients with ŠBT1 were younger, leaner, majority had newly diagnosed disease and hyperglycemia was the main cause of admission. During a median follow-up of 33.4 months, mortality rate in NKH patients was 40.9%, 30.2% in DK patients, 44.5% in DKA patients and 46.4% in DHS patients. Patients with DK had lower moratlity when compared with NKH patients (HR 0.63, 95% CI, 0.48 - 0.82; P = 0.0005). Patients with DKA had higher mortality than DK patients (HR 1.92, 95% CI 1.41 - 2.61, P
Databáze: OpenAIRE
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