Endocrinol Metab.  2016 Sep;31(3):424-432. 10.3803/EnM.2016.31.3.424.

Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis

Affiliations
  • 1Department of Medicine, King George's Medical College, Lucknow, India. manish07gutch@gmail.com
  • 2Department of Obstetrics and Gynecology, King George's Medical College, Lucknow, India.
  • 3Department of Radiodiagnosis, King George's Medical College, Lucknow, India.
  • 4Department of Pulmonary Medicine, King George's Medical College, Lucknow, India.
  • 5Department of Physical Medicine and Rehabilitation, King George's Medical College, Lucknow, India.

Abstract

BACKGROUND
Diabetic ketoacidosis (DKA) is characterized by a biochemical triad of hyperglycemia, acidosis, and ketonemia. This condition is life-threatening despite improvements in diabetic care. The purpose of this study was to evaluate the clinical and biochemical prognostic markers of DKA. We assessed correlations in prognostic markers with DKA-associated morbidity and mortality.
METHODS
Two hundred and seventy patients that were hospitalized with DKA over a period of 2 years were evaluated clinically and by laboratory tests. Serial assays of serum electrolytes, glucose, and blood pH were performed, and clinical outcome was noted as either discharged to home or death.
RESULTS
The analysis indicated that significant predictors included sex, history of type 1 diabetes mellitus or type 2 diabetes mellitus, systolic blood pressure, diastolic blood pressure, total leukocyte count, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, blood urea nitrogen, serum creatinine, serum magnesium, serum phosphate, serum osmolality, serum glutamic oxaloacetic transaminases, serum glutamic pyruvic transaminases, serum albumin, which were further regressed and subjected to multivariate logistic regression (MLR) analysis. The MLR analysis indicated that males were 7.93 times more likely to have favorable outcome compared with female patients (odds ratio, 7.93; 95% confidence interval, 3.99 to 13.51), while decreases in mean APACHE II score (14.83) and serum phosphate (4.38) at presentation may lead to 2.86- and 2.71-fold better outcomes, respectively, compared with higher levels (APACHE II score, 25.00; serum phosphate, 6.04).
CONCLUSION
Sex, baseline biochemical parameters such as APACHE II score, and phosphate level were important predictors of the DKA-associated mortality.

Keyword

Diabetic ketoacidosis; Hyperglycemia; Ketosis; Hyperglycemic hyperosmolar nonketotic coma

MeSH Terms

Acidosis
APACHE
Blood Pressure
Blood Urea Nitrogen
Creatinine
Diabetes Mellitus, Type 1
Diabetes Mellitus, Type 2
Diabetic Ketoacidosis*
Electrolytes
Female
Glucose
Humans
Hydrogen-Ion Concentration
Hyperglycemia
Hyperglycemic Hyperosmolar Nonketotic Coma
Ketosis
Leukocyte Count
Logistic Models
Magnesium
Male
Mortality
Osmolar Concentration
Serum Albumin
Transaminases
Creatinine
Electrolytes
Glucose
Magnesium
Serum Albumin
Transaminases

Figure

  • Fig. 1 Study protocol. DKA, diabetic ketoacidosis.

  • Fig. 2 (A) Age and (B) sex distributions.

  • Fig. 3 Precipitating factors.


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