Retrospective Evaluation of Prognostic Variables and Overall Survival Associated With Nonketotic Hyperosmolar Hyperglycemia in Diabetic Cats: 29 Cases (2000–2020)

Objective: To compare survival between cats diagnosed with a nonketotic hyperosmolar hyperglycemic state (HHS) and cats diagnosed with diabetic ketoacidosis (DKA), and to determine whether clinical parameters, clinicopathologic data, and insulin type are associated with survival. Secondary objectives were to evaluate whether these parameters were associated with survival in cats undergoing a generalized hyperglycemic diabetic crisis. Design: Retrospective evaluation of medical records of cats diagnosed with DKA and HHS between 2000 and 2020. Setting: University teaching hospital. Animals: The HHS group consisted of 29 cats (blood glucose concentration [BG] ≥31.08 mmol/L [≥560 mg/dL]; calculated serum osmolality ≥350 mOsm/kg; ketone negative). The DKA group consisted of 71 cats (BG ≥7.77 mmol/L [≥140 mg/dL]; pH <7.35; ketone positive). Interventions: None. Measurements and Main Results: No clinicopathologic parameters or previous use of glargine U-100 were significantly associated with survival in the HHS group. There was no difference in survival of the HHS group versus the DKA group (65.5% vs. 68.6%; p = 0.85). In all cats, higher serum BUN (p = 0.014), creatinine (p = 0.0098), or BG (p = 0.015) and lower serum sodium concentration (p = 0.03) or body temperature (p = 0.0098) were associated with decreased odds of survival. Calculated total and effective osmolalities were not associated with survival in either group. Conclusions: Cats with HHS had a survival of 65.5% in this study. No serum biochemical parameters predicted prognosis for the HHS group, and insulin type was not found to be associated with survival. Azotemia, hyponatremia, hyperglycemia, and hypothermia were associated with decreased survival when combining all cats. Hyperosmolality was not associated with survival; therefore, distinguishing HHS and DKA into separate syndromes may be arbitrary.