Causes Of Death At Autopsy In Hospitalized Adult Patients With Diabetes Mellitus: A Study From A Developing Country

摘要

In order to determine the causes of death at autopsy in hospitalized adult diabetic patients at the University Hospital of the West Indies (UHWI), we reviewed the autopsy reports of consecutive autopsies performed over a 14-year period (1991 – 2004) in the Department of Pathology at the UHWI. Of the two thousand five hundred and forty-one adult autopsy reports retrieved, 400 (15.7%) represented patients with diabetes mellitus. The commonest cause of death was infection, followed by cardiovascular disease, which showed increasing frequency with time. Hyperglycaemic coma showed a significant decrease in frequency from the first seven-year period to the second. A reduction in mortality may possibly be accomplished through: patient education protocols that re-emphasise the importance of preventing injury and infection and the need for prompt solicitation of medical attention if infections occur; aggressive management of infections; and careful monitoring of cardiovascular function. Factors influencing the presence and severity of vascular disease require further investigation. Introduction It has been widely reported that diabetes mellitus causes excess mortality in affected individuals [1,2,3,4], and that vascular disease, particularly coronary artery disease, is the major cause of death in these patients [1,2,3,5,6,7,8]. This information has largely been derived from studies that have utilized death certificate data [1,2,3,7] to determine cause of death. It has been suggested that cause of death may be inaccurately attributed to coronary artery disease in a significant proportion of death certificates [9] in the population in general, and that, although diabetes is frequently under-recorded on death certificates as an underlying or contributory cause of death [10,11,12], it is more likely to be recorded on the death certificates of those diabetic patients in whom death was deemed to be the result of cardiovascular disease [10]. These factors may have resulted in inaccurate estimates of the contributions of various diseases to death in diabetic patients, and may be different from those that would be obtained if autopsy data were used. A pilot investigation of the causes of death at autopsy, in adult diabetic patients dying at the University Hospital of the West Indies (UHWI) over the period January 1991 – July 1997, found that infection, rather than vascular disease was the commonest cause of death [13]. We decided, therefore, to undertake a definitive investigation into the causes of death in hospitalized adult diabetic patients, in the form of a fourteen-year retrospective autopsy study. To the best of our knowledge, this is the first such study from the English-speaking Caribbean. Patients And Methods We retrospectively analysed autopsy reports from consecutive autopsies performed in the Department of Pathology, University of the West Indies (UWI), over the fourteen-year period January 1991 to December 2004. The department performs autopsies for deaths occurring at the UHWI – the 500-bed multidisciplinary teaching hospital attached to the Faculty of Medical Sciences at the UWI. The hospital exhibits an autopsy rate of 29.2% [14]. All autopsies were complete, and were performed according to standard methodology. In this study, patients are not identified by name or other unique identifiers, such as a hospital registration number, in keeping with the maintenance of patient privacy, dignity and confidentiality, in accordance with the Declaration of Helsinki.The autopsy reports of all patients with diabetes mellitus were selected for analysis. As there were difficulties encountered in retrieving the clinical patient records, the clinical details of the studied patients were obtained solely from the clinical summaries that accompanied the archived post-mortem reports. Consequently, histories of glycaemic control were not available for correlation with autopsy findings. Additionally, the majority of clinical summaries did not indica