The Study of Different Clinical Pattern of Diabetic Ketoacidosis and Common Precipitating Events and Independent Mortality Factors

Mahadevaiah, Mahesh; Shivaswamy, Rajendra Prasad; Chandra, Bj Subhash; Syed, Sajid

doi:10.7860/jcdr/2017/25347.9760

Cited by 16 publications

(26 citation statements)

References 16 publications

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“…In this study, the mortality rate is 1.83%, which is relatively close to that reported in a study conducted at Chang Gung Memorial Hospital, where only 0.67% of the admitted patients with DKA showed no improvement and died [9]. The mortality rate in this study is considered relatively low as compared to other studies that were conducted in Zambia and Malaysia with a mortality rate of 16.66% and 17.6%, respectively [10,11]. Concerning the hospital stay, majority of the patients had a hospital stay of less than or equal to five days, which is considered less than a study that was conducted locally at King Fahad Medical City with an average hospital stay of seven days [12].…”

Section: Discussionsupporting

confidence: 80%

Diabetic Ketoacidosis Treatment Outcome and Associated Factors Among Adult Patients Admitted to the Emergency Department and Medical Wards at King Abdulaziz Medical City, Riyadh, Saudi Arabia

Alotaibi¹,

Aldoukhi²,

Albdah³

et al. 2020

Cureus

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Section: Discussionsupporting

confidence: 80%

Diabetic Ketoacidosis Treatment Outcome and Associated Factors Among Adult Patients Admitted to the Emergency Department and Medical Wards at King Abdulaziz Medical City, Riyadh, Saudi Arabia

Alotaibi¹,

Aldoukhi²,

Albdah³

et al. 2020

Cureus

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“…In the present study approximately five percent of patients died in the hospital which is almost equal to a research done in Israel 4.1 % (35). Mortality was very high 16.66% in a research conducted India (16), 7.5% seven in Zambia (36) and nine percent in another study done in India (37). Still the rate of mortality was relatively high in our study.…”

Section: Discussioncontrasting

confidence: 52%

Treatment Outcome of Diabetic Ketoacidosis Among Patients Atending General Hospital in North-West Ethiopia: Hospital Based Study

Abegaz

Gebreyohannes

et al. 2018

Preprint

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BackgroundDiabetic ketoacidosis is an acute life-threatening complication of diabetes mellitus. There was limited data on level of in-hospital mortality, hospital stay and factors associated with length of hospital stay among diabetic patients admitted to diabetic ketoacidosis at Debretabor General Hospital.ObjectiveThe aim of the study was to determine the length of hospital stay and in-hospital mortality of diabetic ketoacidosis patients and to assess determinants of long hospital stay among diabetic patients admitted with Diabetic ketoacidosis at Debretabor General Hospital.MethodA retrospective study was conducted at Debretabor General Hospital from June 1to 30, 2018. Participants included in the study were all diabetic patients with diabetic ketoacidosis admitted to the hospital from August 2010 to May 31, 2018 whose medical records contained complete pertinent data. The primary outcome was to determine the length of hospital stay and in-hospital mortality of diabetic ketoacidosis patients. All the statistical data was carried out using Statistical Package for Social Sciences (SPSS). Descriptive statistics was presented using means with standard deviation and percentages.ResultA total of 387 patients’ medical records contained pertinent complete information included in this study. Mean age of the patients was 33.30± 14.96 years. The majority of patients were females 244 (63.0%). The mean length of hospital stay was 4.64(±2.802) days. About twenty percent 79(20.41%) patients had long hospital stay (>7days). The majority 370 (95.60%) of patients improved and discharged and 17 (4.40%) patients died in the hospital. patients who had mild DKA; AOR: 0.16 [0.03-0.78] and patients between the age of 35-44years, AOR: 0.125[0.017-0.92] had reduced length of hospital stay. further, patients with DKA precipitated by infection were 4.59 times more likely to have long hospital stay than patients with DKA precipitated by unknown causes; AOR 4.59[1.08-19.42].ConclusionsIn the current study, the mean length of hospital stay was around five days. About twenty percent patients had long hospital stay. Nearly ninety five percent of patientsimproved and discharged. The presence of infection, frequent rebound hyperglycemia and severity of DKA were the major determinants of long hospital stay.

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“…Discontinuation of insulin therapy and infections are the most frequent triggering factors [2,5,8]. Bacterial infections-urinary tract infections in the first place, followed by pneumonia-explain up to 50% of ketoacidosis cases [6,8,9]. In the context of DKA, bacterial infections are reported to increase both mortality [10] and length of stay [9].…”

Section: Introductionmentioning

confidence: 99%

Early sepsis markers in patients admitted to intensive care unit with moderate-to-severe diabetic ketoacidosis

Blanchard

Charbit

Meersch

et al. 2020

Ann. Intensive Care

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Background: Bacterial infections are frequent triggers for diabetic ketoacidosis. In this context, delayed antibiotic treatment is associated with increased morbidity and mortality. Unnecessary administration of antimicrobial therapy might however, also negatively impact the prognosis. The usefulness of sepsis markers in diabetic ketoacidosis has not been assessed. Thus, we sought to investigate diagnostic performances of clinical and biological sepsis markers during diabetic ketoacidosis. Methods: In this monocentric retrospective cohort study, all consecutive episodes of diabetic ketoacidosis (defined as pH ≤ 7.25, glycaemia > 300 mg/dL and presence of ketones) admitted in intensive care unit were included. A proven bacterial infection was defined as bacteriological documentation on any bacterial sample. Clinical (presence of fever: temperature > 38 °C and presence of hypothermia: temperature < 36 °C) and biological markers (whole blood count, neutrophils count, neutrophils-to-lymphocytes count ratio and procalcitonin), recorded at admission, were compared according to the presence or absence of a proven bacterial infection. Results: Between 2011 and 2018, among 134 episodes of diabetic ketoacidosis, 102 were included (91 patients). Twenty out of 102 were infected. At admission, procalcitonin (median: 3.58 ng/mL vs 0.52 ng/mL, p < 0.001) and presence of fever (25% vs 4%, p = 0.007) were different between episodes with and without proven bacterial infection in both univariate and multivariate analysis. Whole blood count, neutrophils count, neutrophils-to-lymphocytes count ratio and presence of hypothermia were not different between both groups. The diagnostic performance analysis for procalcitonin revealed an area under the curve of 0.87 with an optimal cutoff of 1.44 ng/mL leading to a sensitivity of 0.90 and a specificity of 0.76. Combining procalcitonin and presence of fever allowed to distinguish proven bacterial infection episodes from those without proven bacterial infection. Indeed, all patients with procalcitonin level of more than 1.44 ng/mL and fever had proven bacterial infection episodes. The presence of one of these 2 markers was associated with 46% of proven bacterial infection episodes. No afebrile patient with procalcitonin level less than 1.44 ng/ mL had a proven bacterial infection. Conclusion: At admission, combining procalcitonin and presence of fever may be of value to distinguish ketoacidosis patients with and without proven bacterial infection, admitted in intensive care unit.

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The Study of Different Clinical Pattern of Diabetic Ketoacidosis and Common Precipitating Events and Independent Mortality Factors

Cited by 16 publications

References 16 publications

Diabetic Ketoacidosis Treatment Outcome and Associated Factors Among Adult Patients Admitted to the Emergency Department and Medical Wards at King Abdulaziz Medical City, Riyadh, Saudi Arabia

Diabetic Ketoacidosis Treatment Outcome and Associated Factors Among Adult Patients Admitted to the Emergency Department and Medical Wards at King Abdulaziz Medical City, Riyadh, Saudi Arabia

Treatment Outcome of Diabetic Ketoacidosis Among Patients Atending General Hospital in North-West Ethiopia: Hospital Based Study

Early sepsis markers in patients admitted to intensive care unit with moderate-to-severe diabetic ketoacidosis

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