Clinical significance of an elevated on-admission beta-hydroxybutyrate in acutely ill adult patients without diabetes.

Lin, S; Depczynski, B; Varndell, W; Hui, SA; Chiew, A

Clinical significance of an elevated on-admission beta-hydroxybutyrate in acutely ill adult patients without diabetes.

Lin, S Depczynski, B Varndell, W

Hui, SA Chiew, A

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: EMA - Emergency Medicine Australasia, 2024, 36, (4), pp. 527-535
Issue Date:: 2024-08

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Field	Value	Language
dc.contributor.author	Lin, S
dc.contributor.author	Depczynski, B
dc.contributor.author	Varndell, W https://orcid.org/0000-0002-4752-9679
dc.contributor.author	Hui, SA
dc.contributor.author	Chiew, A
dc.date.accessioned	2024-10-09T04:13:10Z
dc.date.available	2024-02-14
dc.date.available	2024-10-09T04:13:10Z
dc.date.issued	2024-08
dc.identifier.citation	EMA - Emergency Medicine Australasia, 2024, 36, (4), pp. 527-535
dc.identifier.issn	1742-6731
dc.identifier.issn	1742-6723
dc.identifier.uri	http://hdl.handle.net/10453/181349
dc.description.abstract	OBJECTIVE: To determine the relationship between point-of-care β-hydroxybutyrate (BHB) concentration and outcomes in adult patients without diabetes admitted through ED. METHODS: This was a prospective study from 10 March to 2 July 2021. Admitted patients without diabetes had capillary BHB sampled in ED. Outcomes of length-of-stay (LOS), composite mortality/ICU admission rates and clinical severity scores (Quick Sepsis Organ Failure Assessment score/National Early Warning Score [qSOFA/NEWS]) were measured. BHB was assessed as a continuous variable and between those with BHB above and equal to 1.0 mmol/L and those below 1.0 mmol/L. RESULTS: A total of 311 patients were included from 2377 admissions. Median length-of-stay was 4.1 days (IQR 2.1-9.8), 18 (5.8%) died and 37 (11.8%) were admitted to ICU. Median BHB was 0.2 mmol/L (IQR 0.1-0.4). Twenty-five patients had BHB ≥1.0 mmol/L and five were >3.0 mmol/L. There was no significant difference in median LOS for patients with BHB ≥1.0 mmol/L compared to non-ketotic patients, 5.3 days (IQR 2.2-7.5) versus 4.1 days, respectively (IQR 2.0-9.8) (P = 0.69). BHB did not correlate with LOS (Spearman ρ = 0.116, 95% confidence interval: 0.006-0.223). qSOFA and NEWS also did not differ between these cohorts. For those 25 patients with BHB ≥1.0 mmol/L, an infective/inflammatory diagnosis was present in 11 (44%), at least 2 days of fasting in 10 (40%) and ethanol intake >40 g within 48 h in 4 (16%). CONCLUSIONS: Routine BHB measurement in patients without diabetes does not add to clinical bedside assessment and use should be limited to when required to confirm a clinical impression.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	EMA - Emergency Medicine Australasia
dc.relation.isbasedon	10.1111/1742-6723.14393
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services
dc.subject.classification	Emergency & Critical Care Medicine
dc.subject.classification	3202 Clinical sciences
dc.subject.mesh	3-Hydroxybutyric Acid
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Biomarkers
dc.subject.mesh	Clinical Relevance
dc.subject.mesh	Emergency Service, Hospital
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Length of Stay
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	Organ Dysfunction Scores
dc.subject.mesh	Point-of-Care Systems
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Female
dc.subject.mesh	Prospective Studies
dc.subject.mesh	3-Hydroxybutyric Acid
dc.subject.mesh	Middle Aged
dc.subject.mesh	Aged
dc.subject.mesh	Adult
dc.subject.mesh	Length of Stay
dc.subject.mesh	Biomarkers
dc.subject.mesh	Organ Dysfunction Scores
dc.subject.mesh	Emergency Service, Hospital
dc.subject.mesh	Point-of-Care Systems
dc.subject.mesh	Clinical Relevance
dc.subject.mesh	Humans
dc.subject.mesh	3-Hydroxybutyric Acid
dc.subject.mesh	Length of Stay
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Middle Aged
dc.subject.mesh	Emergency Service, Hospital
dc.subject.mesh	Point-of-Care Systems
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Organ Dysfunction Scores
dc.subject.mesh	Biomarkers
dc.subject.mesh	Clinical Relevance
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Female
dc.subject.mesh	Prospective Studies
dc.subject.mesh	3-Hydroxybutyric Acid
dc.subject.mesh	Middle Aged
dc.subject.mesh	Aged
dc.subject.mesh	Adult
dc.subject.mesh	Length of Stay
dc.subject.mesh	Biomarkers
dc.subject.mesh	Organ Dysfunction Scores
dc.subject.mesh	Emergency Service, Hospital
dc.subject.mesh	Point-of-Care Systems
dc.subject.mesh	Clinical Relevance
dc.title	Clinical significance of an elevated on-admission beta-hydroxybutyrate in acutely ill adult patients without diabetes.
dc.type	Journal Article
utslib.citation.volume	36
utslib.location.activity	Australia
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/School of Nursing and Midwifery
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.rights.license	This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/
dc.date.updated	2024-10-09T04:13:08Z
pubs.issue	4
pubs.publication-status	Published
pubs.volume	36
utslib.citation.issue	4

Abstract:

OBJECTIVE: To determine the relationship between point-of-care β-hydroxybutyrate (BHB) concentration and outcomes in adult patients without diabetes admitted through ED. METHODS: This was a prospective study from 10 March to 2 July 2021. Admitted patients without diabetes had capillary BHB sampled in ED. Outcomes of length-of-stay (LOS), composite mortality/ICU admission rates and clinical severity scores (Quick Sepsis Organ Failure Assessment score/National Early Warning Score [qSOFA/NEWS]) were measured. BHB was assessed as a continuous variable and between those with BHB above and equal to 1.0 mmol/L and those below 1.0 mmol/L. RESULTS: A total of 311 patients were included from 2377 admissions. Median length-of-stay was 4.1 days (IQR 2.1-9.8), 18 (5.8%) died and 37 (11.8%) were admitted to ICU. Median BHB was 0.2 mmol/L (IQR 0.1-0.4). Twenty-five patients had BHB ≥1.0 mmol/L and five were >3.0 mmol/L. There was no significant difference in median LOS for patients with BHB ≥1.0 mmol/L compared to non-ketotic patients, 5.3 days (IQR 2.2-7.5) versus 4.1 days, respectively (IQR 2.0-9.8) (P = 0.69). BHB did not correlate with LOS (Spearman ρ = 0.116, 95% confidence interval: 0.006-0.223). qSOFA and NEWS also did not differ between these cohorts. For those 25 patients with BHB ≥1.0 mmol/L, an infective/inflammatory diagnosis was present in 11 (44%), at least 2 days of fasting in 10 (40%) and ethanol intake >40 g within 48 h in 4 (16%). CONCLUSIONS: Routine BHB measurement in patients without diabetes does not add to clinical bedside assessment and use should be limited to when required to confirm a clinical impression.

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http://hdl.handle.net/10453/181349