Short-Term Case Fatality Rate and Associated Factors among Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 15-Year Period

Chen, Hua-Fen; Wang, Chih‐Yuan; Lee, Hsinyu; Shu, Tingting; Chen, Mei-Hsiu; Jiang, Ju-Ying; Lee, Ming-Tsang; Li, Chung‐Yi

doi:10.2169/internalmedicine.49.2965

Cited by 47 publications

(27 citation statements)

References 23 publications

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“…More recently other authors have also notified a lower DKA mortality rate at 28 days, ranging between 3.4% 8 and 2.65%. 9 Perhaps, these percentages might be more similar to what could be a priori expected in current day-by-day clinical practice. However, most available data on this issue came from cited manuscripts prior to 1985.…”

Section: Introductionmentioning

confidence: 64%

Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain

Guisado-Vasco¹,

Cano-Megías

Fuente

et al. 2015

Endocrinología y Nutrición (English Edition)

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Aim: To assess the clinical features, length of stay, incidence rate, mortality, and hospital admissions of patients with episodes of diabetic ketoacidosis (DKA). Patients: It was conducted retrospective, cross-sectional study of 164 consecutive admissions of adult patients (2008---August 2012), with type 1 or type 2 diabetes already known or new onset. Results: Mortality rate was 1.2%. The DKA episodes were mild (18.9%), moderate (31.7%), or severe (49.4%). The cumulative incidence was 2.66 cases/1000 patients with diabetes (DM) in 4.5 years. The most common causes triggering DKA were infection (33.2%) and dietary transgression and/or insulin dose omission (30.7%). A total of 12.8% of patients had new onset DM, 56.7% type 1, and 26.8% type 2 DM. Patients with type 2 DM were older and had at admission higher creatinine, BUN, osmolality, sodium, and anion gap levels. Patients with new-onset of DM had higher levels of glucose and sodium, but lower potassium levels. No differences were found in pH or bicarbonate. Admission to the intensive care unit (ICU) was required in >50% of cases (p < 0.001), and 86.6% of patients were finally admitted to a medical ward (p = 0.005). The length of stay at the ICU (p < 0.001) and hospital (p = 0.013) was significantly different depending on DKA severity. Conclusions: Most DKA episodes require hospital admission, but mortality is <2%, and length of stay at the ER and medical ward depends on type of DM and initial severity of the episode. P. Guisado-Vasco et al. PALABRAS CLAVECetoacidosis diabética; Diabetes mellitus; Mortalidad; Hospitalización; Duración de la estancia; Urgencias Características clínicas, mortalidad, hospitalización y duración de la estancia de pacientes adultos con cetoacidosis diabética admitidos en un servicio de urgencias de un hospital terciario en España ResumenObjetivo: Se investigaron las características clínicas, la duración, la tasa de incidencia, la mortalidad y los ingresos de episodios de cetoacidosis diabética (CAD). Pacientes: Se realizó un estudio retrospectivo, transversal, con 164 admisiones consecutivas de adultos (2008---agosto 2012), con diabetes (DM) tipo 1 y 2 ya conocida o debut diabético. Resultados: La tasa de mortalidad fue del 1,2%. Los episodios de CAD fueron leves (18,9%), moderados (31,7%) y graves (49,4%). La incidencia acumulada fue de 2,66 casos/1.000 pacientes con DM en 4,5 años. Las causas desencadenantes más frecuentes fueron las infecciones (33,2%) y la transgresión dietética y/u omisión de la dosis de insulina (30,7%). El 12,8% tuvieron un debut diabético, 56,7% eran DM tipo 1 y el 26,8% tipo 2. Los casos con DM tipo 2 tenían mayor edad y presentaban al ingreso mayores niveles de creatinina, BUN, osmolaridad, sodio y anion GAP. El debut diabético presentaba niveles más elevados de glucosa y sodio, pero valores más bajos de potasio. No se encontró ninguna diferencia en el pH o bicarbonato. La admisión en la unidad de cuidados intensivos (UCI) se requirió en más del 50% de los casos (p < 0,001) y un 86,6% fue finalmente ingresa...

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Section: Introductionmentioning

confidence: 64%

Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain

Guisado-Vasco¹,

Cano-Megías

Fuente

et al. 2015

Endocrinología y Nutrición (English Edition)

View full text Add to dashboard Cite

show abstract

“…Patient information also came from an administrative dataset with the potential for misclassification of patients (29). However, other studies have used billing data to study DKA (10,11) and the demographics of our cohort (specifically, the mean age and the percentage of patients with diabetes who had DKA) are consistent with other more detailed clinical cohorts (11,(30)(31)(32). Additionally, severity of acute illness was not captured in our dataset; thus, it is possible that DKA patients at some institutions were more critically ill than at others and may account for some of the variation in triage practice.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were identified by the ICD-9-CM code 250.1× as in other epidemiologic studies of DKA (10,11).…”

Section: Patientsmentioning

confidence: 99%

Variation In Use Of Intensive Care For Adults With Diabetic Ketoacidosis

Gershengorn¹,

Iwashyna²,

Cooke³

et al. 2012

A46. Intensive Care Unit Management and Rapid Response: Provider and Patient Outcomes

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Objective-Intensive care unit (ICU) beds are limited, yet few guidelines exist for triage of patients to the ICU, especially patients at low-risk for mortality. The frequency with which lowrisk patients are admitted to ICUs in different hospitals is unknown. Our objective was to assess variation in use of intensive care for patients with diabetic ketoacidosis (DKA), a common condition with a low-risk of mortality.Design-Observational study using the New York State Inpatient Database (2005Database ( -2007. Setting-159New York State acute care hospitals.Patients-15,994 adult (≥18) hospital admissions with a primary diagnosis of DKA (ICD-9-CM 250.1x). Interventions-None.Measurements and Main Results-We calculated reliability-and risk-adjusted ICU utilization, hospital length of stay (LOS), and mortality. We identified hospital-level factors associated with increased likelihood of ICU admission after controlling for patient characteristics using multilevel mixed-effects logistic regression analyses; we assessed the amount of residual variation in ICU utilization using the intra-class correlation coefficient. Use of intensive care for DKA patients varied widely across hospitals (adjusted range: 2.1% to 87.7%), but was not associated with hospital LOS or mortality. After multilevel adjustment, hospitals with a high each additional ten percent increase). In the multi-level model, more than half (58%) of the variation in ICU admission practice attributable to hospitals remained unexplained.Conclusions-We observed variation across hospitals in use of intensive care for DKA patients that was not associated with differences in hospital LOS or mortality. Institutional practice patterns appear to impact admission decisions and represent a potential target for reduction of resource utilization in higher use institutions.

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“…2 Precipitating causes must be identified and addressed to reduce mortality related to diabetic ketoacidosis. 2 Infection is the most common precipitant for diabetic ketoacidosis. Other precipitating factors include acute illness (e.g., myocardial infarction), medications and inadequate insulin therapy.…”

Section: Discussionmentioning

confidence: 99%

“Safety” technology: a hidden cause of diabetic ketoacidosis

Yu¹

2012

CMAJ

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Short-Term Case Fatality Rate and Associated Factors among Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 15-Year Period

Abstract: Background and Purpose Diabetic ketoacidosis (DKA) 5-year periods (i.e, 1991-1995, 1996-2000, 2001-2005 2001-2005 (2.65% and 11.63% in DKA and HHS, respectively

Cited by 47 publications

References 23 publications

Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain

Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain

Variation In Use Of Intensive Care For Adults With Diabetic Ketoacidosis

“Safety” technology: a hidden cause of diabetic ketoacidosis

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