Seventy-Two Hour Mortality Prediction Model in Patients with Diabetic Ketoacidosis: A Retrospective Cohort Study

Authors

Keywords:

prediction model, mortality, diabetic ketoacidosis

Abstract

*Visual Abstracts prepared by Dr. Carmen Carina Cabrera

Objective. This study aims to identify predictors of 72-hour mortality in patients with diabetic ketoacidosis (DKA).

Methodology. In this retrospective cohort study, data were obtained from medical records of adult patients with DKA in Cipto Mangunkusumo General Hospital from January 2011 to June 2017. Associations of predictors (age, type of diabetes, history of DKA, comorbidities, level of consciousness, renal function, bicarbonate, potassium, lactate, betahydroxybutyrate levels, and anion gap status) and 72-hour mortality were analyzed. The mortality prediction model was formulated by dividing the coefficient B by the standard error for all variables with p<0.05 in the multivariate analysis.

Results. Eighty-six of 301 patients did not survive 72 hours after hospital admission. Comorbidities (HR 2.407; 95% CI 1.181–4.907), level of consciousness (HR 10.345; 95% CI 4.860–22.019), history of DKA (HR 2.126; 95% CI 1.308–3.457), and lactate level (HR 5.585; 95% CI 2.966–10.519) were significant predictors from multivariate analysis and were submitted to the prediction model. The prediction model had good performance. Patients with total score less than 3 points were at 15.41 % risk of mortality, 3–4 points were 78.01% and 5–6 points were 98.22% risk of mortality.

Conclusion. The 72-hour mortality rate in Cipto Mangunkusumo General Hospital was 28.57%. The mortality prediction model had a good performance and consisted of comorbidities, history of DKA, level of consciousness and lactate level.

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References

Jervis A, Champion S, Figg G, Langley J, Adams GG. Prevalence of diabetic ketoacidosis rises and still no strict treatment adherence. Curr Diabetes Rev. 2013;9(1):54-61. PMID: 23062215.

Gosmanov AR, Gosmanova EO, Dillard-Cannon E. Management of adult diabetic ketoacidosis. Diabetes Metab Syndr Obes. 2014;7:255–64. PMID: 25061324. PMCID: PMC4085289.

Alourfi Z, Homsi H. Precipitating factors, outcomes, and recurrence of diabetic ketoacidosis at a university hospital in Damascus. Avicenna J Med. 2015;5(1):11–5. PMID: 25625084.PMCID: PMC4296391.

Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335–43. PMID: 19564476.PMCID: PMC2699725.

Suwarto S, Sutrisna B, Waspadji S, Pohan H. Predictors of five-day mortality in diabetic ketoacidosis patients: A prospective cohort study. Acta Med Indones. 2014;46(1):18–23. PMID: 24760804.

MacIsaac RJ, Lee LY, McNeil KJ, Tsalamandris C, Jerums G. Influence of age on the presentation and outcome of acidotic and hyperosmolar diabetic emergencies. Intern Med J. 2002;32(8):379-85. PMID: 12162394.

Henriksen OM, Røder ME, Prahl J, Svendsen OL. Diabetic ketoacidosis in Denmark incidence and mortality estimated from public health registries. Diabetes Res Clin Pract. 2007;76(1):51–6. PMID: 16959363. https://doi.org/10.1016/j.diabres.2006.07.024.

Ko SH, Lee WY, Lee JH, et al. Clinical characteristics of diabetic ketoacidosis in Korea over the past two decades. Diabet Med. 2005;22(4):466–9. PMID: 15787674. https://doi.org/10.1111/j.1464-5491.2005.01450.x.

Efstathiou SP, Tsiakou AG, Tsioulos DI, et al. A mortality prediction model in diabetic ketoacidosis. Clin Endocrinol (Oxf). 2002;57(5):595–601. PMID: 12390332.

Barski L, Nevzorov R, Rabaev E, et al. Diabetic ketoacidosis: Clinical characteristics, precipitating factors and outcomes of care. Isr Med Assoc J. 2012;14(5):299-303. PMID: 22799061.

Mills LS, Stamper JE. Adult diabetic ketoacidosis: Diagnosis, management and the importance of prevention. J Diabetes Nurs. 2014;18(1):8-12.

https://www.diabetesonthenet.com/uploads/resources/dotn/_master/3613/files/pdf/jdn18-1-8-12.pdf.

Venkatesh B, Pilcher D, Prins J, Bellomo R, Morgan TJ, Bailey M. Incidence and outcome of adults with diabetic ketoacidosis admitted to ICUs in Australia and New Zealand. Critical Care. 2015;19:451. PMID: 26715333. PMICD: PMC4699354.

Gibb FW, Teoh WL, Graham J, Lockman KA. Risk of death following admission to a UK hospital with diabetic ketoacidosis. Diabetologia. 2016;59(10):2082–7. PMID: 27397023. PMCID: PMC5016550. https://doi.org/10.1007/s00125-016-4034-0.

Agarwal A, Yadav A, Gutch M, et al. Prognostic factors in patients hospitalized with diabetic ketoacidosis. Endocrinol Metab (Seoul). 2016;31(3):424-32. PMID: 27586452. PMCID: PMC5053055. https://doi.org/10.3803/EnM.2016.31.3.424.

Kakusa M, Kamanga B, Ngalamika O, Nyirenda S. Comatose and noncomatose adult diabetic ketoacidosis patients at the university teaching hospital, Zambia: Clinical profiles, risk factors and mortality outcomes. Indian J Endocrinol Metab. 2016;20(2):199-205. PMID: 27042416. PMCID: PMC4792021. https://doi.org/10.4103/2230-8210.176358.

Hendarto H. Gambaran kadar laktat darah pada penderita ketoasidosis diabetik yang meninggal pada 24 jam pertama di Instalasi Gawat Darurat RSUPN-CM antara bulan Maret-Agustus 2002. Thesis. Universitas Indonesia: 2003.

Huang YQ, Gou R, Diao YS, et al. Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy. J Zhejiang Univ Sci B 2014;15(1):58-66. PMID: 24390745. PMCID: PMC3891119. https://doi.org/10.1631/jzus.B1300109.

Umpierrez GE, Murphy MB, Kitabchi AE. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Diabetes Spectr. 2002;15(1):28-36. https://doi.org/10.2337/diaspect.15.1.28.

Chiasson JL, Aris-Jilwan N, Bélanger R, et al. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. CMAJ. 2003;168(7):859–66. PMID: 12668546. PMCID: PMC151994.

Waspadji S. Penatalaksanaan Kedaruratan di Bidang Ilmu Penyakit Dalam. PIP Bagian Ilmu Penyakit Dalam FKUI RSUPNCM, 2000.

Snorgaard O, Eskildsen PC, Vadstrup S, Nerup J. Diabetic ketoacidosis in Denmark: Epidemiology, incidence rates, precipitating factors and mortality rates. J Intern Med.1989;226(4):223–8. https://doi.org/10.1111/j.1365-2796.1989.tb01384.x.

Ellemann K, Soerensen JN, Pedersen L, Edsberg B, Andersen OO. Epidemiology and treatment of diabetic ketoacidosis in a community population. Diabetes Care. 1984;7(6):528–32. PMID: 6439530.

Mays JA, Jackson KL, Derby TA, et al. An evaluation of recurrent diabetic ketoacidosis, fragmentation of care, and mortality across Chicago, Illinois. Diabetes Care. 2016;39(10):1671-6. PMID: 27422579. https://doi.org/10.2337/dc16-0668.

Cooper H, Tekiteki A, Khanolkar M, Braatvedt G. Risk factors for recurrent admissions with diabetic ketoacidosis: A case-control observational study. Diabet Med. 2016;33(4):523–8. PMID: 26489986. https://doi.org/10.1111/dme.13004.

Pishdad G, Ghavanini AA. Factors contributing to alterations in the level of consciousness in patients with diabetic ketoacidosis: Analysis of 189 cases. Med J Islam Repub Iran. 1999;13(2):699-702.

Nyenwe EA, Razavi LN, Kitabchi AE, Khan AN, Wan JY. Acidosis: The prime determinant of depressed sensorium in diabetic ketoacidosis. Diabetes Care. 2010; 33(8):1837–9. PMID: 20484127 PMCID: PMC2909073. https://doi.org/10.2337/dc10-0102.

Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate. Mayo Clin Proc. 2013;88(10):1127–40. PMID: 24079682. PMCID: PMC3975915. NIHMSID: NIHMS564727. https://doi.org/10.1016/j.mayocp.2013.06.012.

Published

2018-09-03

How to Cite

Siregar, N., Soewondo, P., Subekti, I., & Muhadi, M. (2018). Seventy-Two Hour Mortality Prediction Model in Patients with Diabetic Ketoacidosis: A Retrospective Cohort Study. Journal of the ASEAN Federation of Endocrine Societies, 33(2), 124. Retrieved from https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/459

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