糖尿病酮症酸中毒和高渗性高血糖综合征的精神障碍和药物使用障碍及其与临床结果的关系。

IF 2.7 4区 心理学 Q2 PSYCHIATRY Journal of the Academy of Consultation-Liaison Psychiatry Pub Date : 2024-09-01 DOI:10.1016/j.jaclp.2024.02.007
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引用次数: 0

摘要

背景:糖尿病酮症酸中毒(DKA)和高渗性高血糖状态(HHS)是一种危及生命的疾病,每年有近 18 万患者被送入重症监护室,死亡率高达 5-10%。人们对并发精神障碍对 DKA/HHS 具体结果的影响知之甚少。确定这些关系为改善临床管理、治疗计划以及降低相关发病率和死亡率提供了机会:我们对马萨诸塞州一家大型医院系统在 2010 - 2019 年期间收治的成人 DKA/HHS 患者进行了回顾性分析。我们确定了因 DKA 或 HHS 而入院的患者,然后通过 ICD-9-CM、ICD-10-CM 代码筛选出患者 EMR 中在观察期内任何时间点出现的精神科诊断。结果包括因 DKA/HHS 住院的人数、死亡年龄、任何住院病例的违抗医嘱出院率 (AMA) 以及 ESRD/透析状态。使用 R 软件进行多变量回归,以控制不同患者的变量,并评估结果与并发精神疾病之间的关系。显著性以 p 为标准:7756 名患者因 DKA 或 HHS 入院,其中 66.9% 的患者同时患有精神疾病。其中 54.5% 为男性,70.4% 为白人,平均年龄为 61.6 岁。相比之下,在普通糖尿病患者中,有 26.1% 同时患有精神疾病,其中 52.1% 为男性,72.1% 为白人,平均年龄为 68.2 岁。并发精神障碍与再次住院的几率增加有关(aOR= 1.62 95%Cl 1.35 - 1.95, p结论:66.9% 的 DKA/HHS 患者并发精神障碍。因 DKA/HHS 而入院的并发精神障碍患者更有可能多次入院、离开 AMA、接受肾透析,且死亡率较低。
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Psychiatric and Substance Use Disorders and Their Association With Clinical Outcomes in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome

Background and Objective

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the intensive care unit each year, with mortality rates up to 5–10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality.

Methods

We conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 to 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by International Classification of Disease-9-CM and International Classification of Disease-10-CM codes for psychiatric diagnoses that were present in patients electronic medical record at any point in this observational period. Outcomes included the number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and end-stage renal disease/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at P < 0.05.

Results

Seven thousand seven hundred fifty-six patients were admitted for DKA or HHS, 66.9% of whom had a concurrent psychiatric disorder. Of these patients, 54.5% were male, 70.4% were White, and they had an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of whom were male, 72.1% were White, and an average age of 68.2 years. A concurrent psychiatric disorder was associated with increased odds of rehospitalization (adjusted odds ratio [aOR] = 1.62 95% confidence interval [CI] 1.35–1.95, P < 0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% CI 1.002–1.035, P = 0.02), and of leaving AMA (aOR = 6.44 95% CI 4.46–9.63, P < 0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of −7.5 years (95% CI −9.3 to 5.8) compared to those without a psychiatric disorder.

Conclusions

Of patients with DKA/HHS, 66.9% have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and to have a lower age of mortality.
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