A prevalência e incidência precisas do estado hiperosmolar hiperglicêmico (EHH) são difíceis de determinar em decorrência da falta de estudos de base populacional e das múltiplas comorbidades frequentemente encontradas nesses pacientes. No entanto, a prevalência geral é estimada em menos de 1% de todas as internações hospitalares relacionadas ao diabetes.[5]Pasquel FJ, Tsegka K, Wang H, et al. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020 Feb;43(2):349-57.
https://care.diabetesjournals.org/content/43/2/349.long
http://www.ncbi.nlm.nih.gov/pubmed/31704689?tool=bestpractice.com
[14]Umpierrez GE, Kelly JP, Navarrete JE, et al. Hyperglycemic crises in urban Blacks. Arch Intern Med. 1997 Mar 24;157(6):669-75.
http://www.ncbi.nlm.nih.gov/pubmed/9080921?tool=bestpractice.com
[15]Kitabchi AE, Fisher JN, Murphy MB, et al. Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. In: Kahn CR, Weir GC, eds. Joslin's diabetes mellitus. 13th ed. Philadelphia, PA: Lea and Febiger; 1994:738-70.
O EHH é observado mais comumente em pessoas idosas com diabetes do tipo 2 mal controlado.[2]Mustafa OG, Haq M, Dashora U, et al. Management of hyperosmolar hyperglycaemic state (HHS) in adults: an updated guideline from the Joint British Diabetes Societies (JBDS) for inpatient care group. Diabet Med. 2023 Mar;40(3):e15005.
https://onlinelibrary.wiley.com/doi/10.1111/dme.15005
http://www.ncbi.nlm.nih.gov/pubmed/36370077?tool=bestpractice.com
[3]Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. 2017 Dec 1;96(11):729-36.
https://www.aafp.org/afp/2017/1201/p729.html
http://www.ncbi.nlm.nih.gov/pubmed/29431405?tool=bestpractice.com
As taxas de mortalidade relatadas no EHH variam.[1]Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11343900
http://www.ncbi.nlm.nih.gov/pubmed/38907161?tool=bestpractice.com
Nos Estados Unidos, entre 2008 e 2018, houve um aumento relatado nas hospitalizações por EHH em pacientes com diabetes do tipo 2; no entanto, a mortalidade intra-hospitalar diminuiu de 1.44% para 0.77%.[16]Shaka H, El-Amir Z, Wani F, et al. Hospitalizations and inpatient mortality for hyperosmolar hyperglycemic state over a decade. Diabetes Res Clin Pract. 2022 Mar;185:109230.
http://www.ncbi.nlm.nih.gov/pubmed/35122906?tool=bestpractice.com
As taxas de mortalidade são mais elevadas em países de baixa e média renda, com taxas registadas de até 20.3% na Jamaica.[17]Chung ST, Perue GG, Johnson A, et al. Predictors of hyperglycaemic crises and their associated mortality in Jamaica. Diabetes Res Clin Pract. 2006 Aug;73(2):184-90.
http://www.ncbi.nlm.nih.gov/pubmed/16458989?tool=bestpractice.com
A mortalidade aumenta significativamente quando o paciente tem mais de 70 anos de idade.[18]Wachtel TJ, Silliman RA, Lamberton P. Prognostic factors in the diabetic hyperosmolar state. J Am Geriatr Soc. 1987 Aug;35(8):737-41.
http://www.ncbi.nlm.nih.gov/pubmed/3611564?tool=bestpractice.com
As taxas de mortalidade relatadas são mais elevadas para aqueles com cetoacidose diabética (CAD)/EHH mista em comparação com CAD ou EHH isoladamente.[1]Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11343900
http://www.ncbi.nlm.nih.gov/pubmed/38907161?tool=bestpractice.com
[5]Pasquel FJ, Tsegka K, Wang H, et al. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020 Feb;43(2):349-57.
https://care.diabetesjournals.org/content/43/2/349.long
http://www.ncbi.nlm.nih.gov/pubmed/31704689?tool=bestpractice.com
Um estado combinado de hiperglicemia grave, hiperosmolalidade e acidose metabólica é observado em cerca de 24% a 33% de todas as emergências hiperglicêmicas.[5]Pasquel FJ, Tsegka K, Wang H, et al. Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study. Diabetes Care. 2020 Feb;43(2):349-57.
https://care.diabetesjournals.org/content/43/2/349.long
http://www.ncbi.nlm.nih.gov/pubmed/31704689?tool=bestpractice.com
[17]Chung ST, Perue GG, Johnson A, et al. Predictors of hyperglycaemic crises and their associated mortality in Jamaica. Diabetes Res Clin Pract. 2006 Aug;73(2):184-90.
http://www.ncbi.nlm.nih.gov/pubmed/16458989?tool=bestpractice.com
[19]Magee MF, Bhatt BA. Management of decompensated diabetes. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Crit Care Clin. 2001 Jan;17(1):75-106.
http://www.ncbi.nlm.nih.gov/pubmed/11219236?tool=bestpractice.com