Prostitutas y suegras en espacios cerrados

This study includes five outcome measures under the umbrella of (O). The first measure

is mortality, which is the most commonly used measure for (O) among HG studies as well as

studies that employed the BM for other diseases. Second is CV complications; they are found to

be significantly associated with HG in numerous studies. Third is sepsis, which is a slightly less

common outcome, but it is far-reaching and usually associated with higher levels of (U). The last

two, patient falls and seizures, are less severe but more commonly found among HG patients.

2.6.2.1 Mortality

Diabetic patients who present to the ED with HG or develop in-hospital HG are

considered at a higher risk of death. A recently published study examined the hospital discharge

records of more than 5.4 million diabetic patients from 1997-2010 and found that those who

developed HG in the hospital were 12% more likely to die in the hospital (OR 1.12, 95% CI

1.09-1.15) (Gómez et al., 2015). Another study examined extensive data from 70 hospitals from

CI 1.2-1.11) (Curkendall et al., 2009). However, the risk of mortality varied based on the

severity of HG. Those with more severe HG were usually at a higher risk of mortality than were

others with less severe HG. A retrospective cohort study analyzed 4,368 admissions between

2003-2004 and found that the odds of inpatient death increased three times for every 10 mg/dl

decrease in BG (Turchin et al., 2009).

The relationship between in-hospital HG and mortality was also consistent with other

studies conducted in other countries. In the UK, one study found that inpatient mortality was 5-

15% among patients with HG (Nirantharakumar et al., 2012) and another UK study found it to be

7.6% (Brodovicz et al., 2013). In Spain, discharged patients’ records between 2005-2010 showed

that 10.2% of those who develop inpatient HG died in the hospital compared to 9.5% without

HG (OR 1.08, 95% CI 1.05-1.11) (Zapatero et al., 2014).

2.6.2.2 Cardiovascular (CV) Complications

HG steadily has been found to be a risk factor for developing a broad range of adverse

CV complications in many systematic review studies (Goto et al., 2013; Yeh et al., 2015). These

complications include MI, stroke, and arrhythmias (Johnston et al., 2011; Khunti et al., 2015).

Another systematic review was conducted in 2013 to summarize the available data on the

pathophysiology behind HG and CV complications (Hanefeld, Duetting, & Bramlage, 2013). It

found that HG lead to CV complications by elevating the thrombotic tendency, affecting cardiac

repolarization, provoking inflammation, and accelerating the process of development of

atherosclerosis.

A 2013 systematic review and meta-analysis found that SH was strongly associated with

et al. found that stroke was a common comorbidity that independently associated with HG (OR

2.84, 95% CI 2.31–3.48) followed by heart failure (HF) (OR 2.04, 95% CI 1.65–2.51) (Hsu et

al., 2013). Simeone and Quilliam (2012) found that ED-treated HG cases usually had HF (OR

1.70, 95% CI 1.49-1.93), peripheral vascular disease (OR 1.80, 95% CI 1.60-2.02), arrhythmia

(OR 1.22, 95% CI 1.04-1.44), and stroke (OR 1.81, 95% CI 1.41-2.32). In another study,

Quilliam et al. (2011) found various CV complications that were independently associated with

inpatient HG. For example, theu study found that arrhythmia is higher among HG patients (OR

1.69, 95%CI 1.17–2.44), coronary artery disease (CAD) (OR 1.48, 95%CI 1.21–1.81), HF (OR

2.33, 95%CI 1.72–3.15), and stroke (OR 2.78, 95%CI 1.62–4.77) (Quilliam et al., 2011).

Hospital admissions were common among HG patients with CV complications as well. When

comparing patients without HG with those having HG, Hsu et al. (2013) found a higher

hospitalization rate per 1,000 person-years for stroke (27.97 vs. 69.05), HF (27.96 vs. 65.51) and

other CV diseases (106.00 vs. 323.36).

2.6.2.3 Sepsis

Sepsis is one of the most common unpleasant in-hospital complications among HG

patients. A retrospective chart review of adult patients showed that the prevalence of sepsis was

higher among those who developed HG than it was for those without HG (Blosch et al., 2010).

Another retrospective cohort study of data from 70 hospitals also showed that diabetics who

present to the hospital with HG had higher odds of developing sepsis (OR 6.9, 95% CI 6.3-7.4)

than other diabetics without HG had(OR 2.2, 95% CI 2.1-2.3) (Curkendall et al., 2009). Besides

sepsis at presentation, a study on over 5,000 diabetic patients admitted in 2010 found that the

(Dendy et al., 2014). Dendy et al. (2014) noted that the risk of developing septicemias among

HG patients increased with the severity of HG, and found that the SH group had statistically

higher proportions of sepsis (49.4%) compared to non-SH (12.5%). Abdelhafiz et al. (2012)

found that sepsis was more likely to be found among HG patients than others with no HG (18%

vs. 1.8%, P < 0.001).

2.6.2.4 Patient falls

In general, falls are undesired because they usually lead to fractures, hospital admissions,

longer LoS, more utilization of healthcare resources, higher costs, and sometimes deaths

(Chevalier et al., 2016). HG is one of the major factors that leads to patient falls at their homes. It

has been estimated that HG events increase the odds of falls-related fractures by 70% (OR 1.7,

CI 95% 1.58–1.83) (Johnston et al., 2012). Among hospitalized patients, falls and fall-related

fractures are not uncommon among HG patients. One study in Australia included over 11,000

patients between 1996-1998 and showed that patient falls occurred at a rate of 291.2 per 100,000

people per year (Kennedy, Chapman, Nayar, Grant, & Morris, 2002; Malabu et al., 2014).

Another Belgian study estimated that accidental falls were reported in 11.2% of the HG-related

hospitalizations (Chevalier et al., 2016). A study included a large U.S. database from 1998–2010

of non-insulin treated T2DM and found that HG increased the hazards of falls by 17% among

hospitalized patients younger than 65 years (HR 1.17, 95% CI 0.88, 1.57), and 36% for those

older than 65 years (HR 1.36, 95% CI 1.13–1.6) (Signorovitch et al., 2013). Kachroo et al.

(2015) also found that elderly patients were usually found to have twice the risk for falls than

2.6.2.5 Seizures

Seizures that are due to hypoglycemia are one of the unpleasant neurological

complications of HG because they sometimes lead to permanent neuronal damage or even death

(Stafstrom, 2008). A retrospective cohort study of data from 70 hospitals found that diabetics

who presented to the hospital with HG had higher odds of developing seizures (OR 3.0, 95% CI

2.7-3.4) than did other diabetics without HG (OR 2.2, 95% CI 2.1-2.2) (Curkendall et al., 2009).

Holstein, Hammer, and Egberts (2003) estimated that 5% of HG cases presented to the ED had

seizures. Another prospective, population-based study over four years in Germany revealed that

about 7% of hospitalized diabetic patients with HG had seizures (Holstein & Egberts, 2001).