Characteristics and outcomes of the hyperglycemic hyperosmolar non-ketotic syndrome in a cohort of 51 consecutive cases at a single center

Diabetes Res Clin Pract. 2011 Nov;94(2):172-9. doi: 10.1016/j.diabres.2011.06.018. Epub 2011 Jul 12.


Aims: The hyperglycemic hyperosmolar syndrome (HHS) is a life-threatening diabetic complication. We aimed to portrait the short and long term outcome after a HHS episode and to describe features associated with increased early mortality.

Methods: We collected data from consecutive HHS cases, defined based on rigorous glucose and osmolality criteria. We retrieved anthropometric measures, history of diabetes, other cardiovascular risk factors and chronic co-morbidity. Clinical and biochemical parameters were recorded at admission, after 24h and at discharge. We assessed incidence of complications, as well as short (≤ 30 days) and long term mortality.

Results: Patients were about 80-year old. Fifty-one cases were included, characterized by severe hyperglycemia (55.5 mosm/L) and hyperosmolality (385 mosm/L). Thirty-three percent developed at least one complication. Short term mortality was 16%; lower Glasgow Coma Scale, higher plasma glucose and mild acidosis were predictive of short term mortality. The long term mortality (median follow-up 1.27 years) was not significantly different from historical mortality data after hypoglycemic coma.

Conclusion: In this study, early mortality of HHS was 16% and some clinical features at presentation were predictive of an adverse short term outcome. Long term survival after a HHS episode did not appear to be severely impaired.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Biomarkers / blood
  • Chi-Square Distribution
  • Cohort Studies
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / diagnosis
  • Diabetes Mellitus, Type 2* / mortality
  • Diabetes Mellitus, Type 2* / therapy
  • Female
  • Hospital Mortality
  • Humans
  • Hyperglycemic Hyperosmolar Nonketotic Coma* / diagnosis
  • Hyperglycemic Hyperosmolar Nonketotic Coma* / etiology
  • Hyperglycemic Hyperosmolar Nonketotic Coma* / mortality
  • Hyperglycemic Hyperosmolar Nonketotic Coma* / therapy
  • Italy
  • Logistic Models
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Survival Rate
  • Time Factors
  • Treatment Outcome


  • Biomarkers