Mortality rates and associated risk factors in patients in intensive care unit for endocrinological reasons

Introduction-Aim: Endocrine emergencies can cause serious health problems requiring admission to the intensive care unit and increase in mortality. This study was carried out to identify mortality rates and associated risk factors in patients in the intensive care unit for endocrine reasons. Instrument-Method: This retrospective study was conducted on the data of 330 patients in the intensive care unit of a hospital for endocrinological reasons between 2013 and 2023. Indications for hospitalization, clinical and demographic data, and laboratory findings of the patients were recorded for comparison. The patients were grouped based on hospitalization indications including diabetic foot ulcer (DFU), hyperosmolar hyperglycemic state (HHD), diabetic ketoacidosis (DKA), hypoglycemia, and other rare endocrine emergencies. Then, the sub-groups were compared in relation to mortality rates and related risk factors. Findings: Approximately half of the patients (49.7%) suffered from DAU. It was followed by DKA (33.3%) and HHD (10%), respectively. The remaining 10% were diagnosed with adrenal insufficiency, severe hypoglycemia, myxedema coma and thyrotoxic crisis. In the largest sub-groups, the highest mortality rate was seen among DAU patients (31.7%), followed by HHD (21.2%) and DKA (8.1%), respectively. Despite the small number of patients hospitalized for severe hypoglycemia (8 patients, 2.4%), it was interesting to see 2 deaths and a mortality rate of 25% during the follow-up period. In the sub-group with adrenal insufficiency, myxedema coma and thyrotoxic crisis, there was no mortality. In general, significance levels varied among sub-groups. Yet male gender, older age, longer duration of diabetes, presence of diabetic nephropathy, concomitant cardiovascular diseases (hypertension, coronary artery disease, congestive heart failure), low albumin and hemoglobin levels, and high acute phase reactants seemed to be related with increased mortality rates. Conclusion: Most strikingly, the most frequent need for intensive care and the highest mortality rate were found in patients with DFU. In this sub-group, morbidity and mortality rates might be decreased with preventive foot care approaches, reduction of risk factors, early diagnosis and effective treatment strategies. Also, effective combating of chronic micro and macrovascular complications of diabetes and accompanying cardiovascular diseases, which are associated with increased mortality rates in three sub-patients, may contribute to overall survival. Key words: Diabetic Foot Ulcer, Hyperglycemic Hyperosmolar State, Diabetic Ketoacidosis, Hypoglycemia, Intensive Care Unit, Mortality, Cardiovascular Diseases