Predictors of In-Hospital Mortality in Patients With Type 2 Diabetes Complicated by Isolated Hyperosmolar...

BACKGROUND Hyperosmolar hyperglycemic syndrome (HHS) carries a high in-hospital mortality rate. Identifying its in-hospital mortality risk factors is crucial for improving patient outcomes. This study aims to investigate the predictors of in-hospital mortality in patients with type 2 diabetes (T2DM) complicated by isolated HHS. MATERIAL AND METHODS A retrospective analysis was conducted on 102 patients with isolated HHS complicated by T2DM, who were divided into non-survivors (30 cases) and survivors (72 cases) based on in-hospital outcomes. A comparative assessment of clinical characteristics and laboratory findings was performed. Variables with P<0.05 in the univariate logistic regression were entered into the multivariate model to determine independent predictors of mortality. Significant factors identified in the multivariate analysis (P<0.05) were subsequently incorporated into the construction of a mortality prediction model. RESULTS The in-hospital mortality rate was 29.4%. Multivariate logistic regression identified elevated blood urea nitrogen (OR=1.103, 95% CI: 1.021-1.193), cystatin C (OR=1.745, 95% CI: 1.031-2.953), D-dimer (OR=1.058, 95% CI: 1.001-1.118), and Charlson Comorbidity Index score (OR=2.679, 95% CI: 1.257-5.710) as independent predictors of mortality (all P<0.05). Prophylactic administration of low molecular weight heparin (LMWH) was associated with a reduced risk of death (OR=0.033, 95% CI: 0.004-0.302). Receiver operating characteristic analysis demonstrated that cystatin C had the greatest discriminative value (AUC=0.899), with an optimal cut-off of 3.73 mg/L, yielding 80% sensitivity and 91.7% specificity. CONCLUSIONS Elevated blood urea nitrogen, cystatin C, D-dimer levels, and higher Charlson Comorbidity Index scores were identified as independent predictors of in-hospital mortality in patients with T2DM complicated by isolated HHS, whereas prophylactic administration of LMWH was associated with improved survival.