Age is the only independent predictor for the length of hospital stay in patients admitted to a UK district general hospital with diabetic ketoacidosis

Idampitiya, C.; Sithole, Jabulani; Idris, Iskandar

doi:10.1016/j.ejim.2006.05.003

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…Age is reported to be the only factor in lengthening DKA hospital stays in the literature. 16 This study found that age was related to length of hospital stay. SIRS and PH were not related to the length of hospital stay.…”

Section: Discussionmentioning

confidence: 84%

Characteristics of acute pancreatitis with diabetic ketoacidosis and analysis of factors related to the length of hospital stay

Dong¹,

He²,

Yang³

et al. 2020

Preprint

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Obejective 11% of adults with diabetic ketoacidosis (DKA) also suffer from AP. The obejective of this research was to study the characteristics of AP with DKA, the factors related to the length of hospital stay, and to explore indicators for the severity of AP.Methods A retrospective analysis of 173 AP with DKA cases treated in our hospital from July 2011 to December 2020 was performed. We analyzed the gender, age, systemic inflammatory response syndrome(SIRS), pleural effusion, blood urea nitrogen（BUN）, bedside index for the severity in acute pancreatitis（BISAP）score, white blood cell（WBC）, aspartate transaminase （AST）, lactate dehydrogenase（LDH）, blood glucose, Ranson score, partial pressure of carbon dioxide （PaCO 2 ）,triglyceride, modified CT severity index （MCTSI）, potential of hydrogen potential of hydrogen （PH）, amylase, glycated hemoglobin, C-reactive protein（CRP）, creatinine（Cr）, blood calcium, procalcitonin （PCT）, the length of stay.Result Blood calcium, LDH, BUN, pleural effusion, MCTSI, Ranson score and BISAP score were related to the length of stay (P <0.05). WBC, AST, blood glucose, PaCO 2 , triglyceride, PH, glycated hemoglobin, CRP, Cr , PCT were not related to the length of stay (P> 0.05).Conclusion The current Atlanta classification is not suitable for evaluating the severity of AP with DKA. Serum calcium, LDH, BUN, pleural effusion, and MCTSI are suitable for evaluating the length of stay and severity of AP with DKA.

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Section: Discussionmentioning

confidence: 84%

Characteristics of acute pancreatitis with diabetic ketoacidosis and analysis of factors related to the length of hospital stay

Dong¹,

He²,

Yang³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…After controlling for confounding factors, the mean adjusted LOS was 0.28 days more in the PUD group. Historically, predictors known to prolong LOS in DKA independently include age, concurrent infection, hypokalemia, lower pH on presentation, precipitating cause as infection including urinary tract infection and pneumonia, and severity of DKA based on biochemical markers including serum osmolality, anion gap apart from many others [14–18]. Studies reporting the association of quantitative

{\rm{HCO}}_{3}^{-}

on presentation found contradictory results with both positive and no association reported [14, 17].…”

Section: Discussionmentioning

confidence: 99%

Is acid suppression associated with the increased length of stay in diabetic ketoacidosis patients? A nationwide analysis

et al. 2022

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Background Diabetic ketoacidosis (DKA) patients present with low serum bicarbonate (HCO3−${\rm{HCO}}_{3}^{-} $), and an increase in its level to ≥15 mEq/L is considered one of the criteria for DKA resolution. Both proton pump inhibitors and histamine‐2 receptor antagonists inhibit downstream functioning of H+/K+ ATPase in the gastric parietal cells, which results in the decreased secretion of HCO3−${\rm{HCO}}_{3}^{-} $ into the bloodstream. Objectives We aimed to introduce the hypothesis that DKA patients on acid‐suppressive medications may have a delayed rise in serum HCO3−${\rm{HCO}}_{3}^{-} $ to >15 mEq/L that may cause increased hospital length of stay (LOS) and sought to compare the outcomes of such patients. For the sake of simplicity, conditions requiring acid suppression are grouped under the term peptic ulcer disease (PUD) in this study. Methods This is a retrospective study using Nationwide Inpatient Sample employing International Classification of Diseases (ICD‐10) codes for adult patients with a primary diagnosis of DKA. Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student's t‐test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses. Results DKA patients with PUD had higher adjusted LOS, intensive care unit admission, and total hospital costs. Mortality and morbidity indicators were similar in both groups. The variables found to be independent predictors of increased LOS were malnutrition, Clostridium difficile infection, pneumonia, Glasgow Coma Scale score of 3–8, and higher Charlson comorbidity score. Conclusion We found that Clostridium difficile and pneumonia predicted longer LOS in DKA patients with concomitant PUD, hinting at the possible role of acid suppression in prolonging the LOS in such patients. However, further studies are needed to examine the effect of lesser HCO3−${\rm{HCO}}_{3}^{-} $ generation on LOS.

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“…We also found that age was the only independent predictor for a lower LOS for DKA patients among characteristics such as age, weight, height, and BMI. One study conducted in the United Kingdom also found that age is the only predictor of a lower LOS [ 25 ]. No other studies have replicated our observations that HCO3, anion gap, potassium, and chloride are independent predictors of a lower LOS.…”

Section: Discussionmentioning

confidence: 99%

An Audit of Factors Impacting the Time to Resolution of the Metabolic Parameters in Diabetic Ketoacidosis Patients

AlWahbi¹,

Alharbi²,

Almesned³

et al. 2022

Cureus

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Introduction: Diabetic ketoacidosis (DKA) is a major complication affecting patients with diabetes. It is often the first presentation of type I diabetes and can also occur due to a lack of compliance with insulin therapy or infection, among other causes. Hospitalizations for DKA have increased globally among patients with type I and type II diabetes, which poses a strain on health systems.Aim: To determine the factors impacting the time to resolution of metabolic parameters in DKA patients.Methods: This retrospective study was performed by reviewing the clinical records of hospitalized DKA patients at King Fahad Specialist Hospital, a tertiary-level healthcare center in Buraidah, Al Qassim region, Saudi Arabia. The study included all DKA admissions that met the inclusion criteria between September 2019 and April 2022.Results: A total of 129 patients with a diagnosis of DKA from January 2019 to April 2022 were identified. Of these, 67 patients met the inclusion criteria. More females experienced DKA (56.7%), and the study population had an improvement rate of 97%. The mean length of stay (LOS) for patients with DKA was 73.19 hours, and the median time for DKA resolution was 15 hours (mean time 21.38 hours). The omission of insulin was the leading precipitating factor for DKA (43%) followed by infection (12%). A high serum bicarbonate (HCO 3) level was identified as an independent predictor for a longer time to resolution. Patients with DKA who have high glucose levels on admission, higher body mass index (BMI), older age, and higher weight stayed in the hospital for extended periods. Conversely, patients with a higher serum potential of Hydrogen (pH) had a shorter LOS. Age was the only clinically independent predictor for a minimum LOS for DKA. Patients with comorbidities had a longer hospital LOS than patients without comorbidities; no such relationship has been reported in other studies. Patients in our study population had a longer time of resolution than observed in other studies, although no clear cause was identified.Conclusion: This study contributes to our understanding of DKA in hospitalized patients in Saudi Arabia. This is the first study to link patients with DKA who have comorbidities to a longer hospital stay in the kingdom of Saudi Arabia. This study also identified multiple clinical and biochemical parameters related to the variability in LOS and time to resolution of DKA in hospitalized patients Categories: Endocrinology/Diabetes/Metabolism

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Age is the only independent predictor for the length of hospital stay in patients admitted to a UK district general hospital with diabetic ketoacidosis

Cited by 3 publications

References 2 publications

Characteristics of acute pancreatitis with diabetic ketoacidosis and analysis of factors related to the length of hospital stay

Characteristics of acute pancreatitis with diabetic ketoacidosis and analysis of factors related to the length of hospital stay

Is acid suppression associated with the increased length of stay in diabetic ketoacidosis patients? A nationwide analysis

An Audit of Factors Impacting the Time to Resolution of the Metabolic Parameters in Diabetic Ketoacidosis Patients

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