Treatment Outcomes of Diabetic Ketoacidosis Patients

Main Article Content

Chayanid Rungtivasuwan

Abstract

BACKGROUND: Diabetic ketoacidosis (DKA) is a serious emergency condition in diabetes patients and is associated with significant complications and mortality. Many affected patients experience prolonged hospital stays. In Thailand, data on the factors associated with the length of hospital stay remains limited.


OBJECTIVES: To assess the factors associated with length of hospital stay, mortality rate and precipitating factor among DKA patients.


METHODS: A retrospective study of DKA patients admitted to Bangbo Hospital from July 1, 2020 to June 30, 2024 was carried out. Various factors were analyzed using logistic regression to identify the predictors of longer hospital stays.


RESULTS: A total of 77 patients were included in the study, with their average age being 49.8 years. The majority of patients were female (61%). The mean length of hospital stay was 7.7 days, and the mortality rate was 5.2%. Multivariate logistic regression showed that community acquired infection was associated with a length of stay ≥7 days (adjusted odds ratio=5.03, 95% CI 1.61-15.71, P=0.005). Infections were the most common precipitating factor (59.7%), followed by poor compliance with treatments (45.5%).


CONCLUSIONS: Infection was found to be associated with a longer hospital stay for DKA. Infection and poor compliance remain the major precipitating factors. A strengthened educational program for preventing infections and raising awareness of diabetes control should be emphasized to reduce complications and mortality.


Thaiclinicaltrials.org number, TCTR20241110006

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Original Article

References

Aekplakorn W. Thai national health examination survey and system development for innovation and policy making utilization. Bangkok: Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2023.

Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ [Internet]. 2019 [cited 2024 June 21];365:l1114. Available from: https://www.bmj.com/content/bmj/365/bmj.l1114.full.pdf

Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009;32:1335-43.

Umpierrez GE, Davis GM, ElSayed NA, Fadini GP, Galindo RJ, Hirsch IB, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia 2024;67:1455-79.

Anthanont P, Khawcharoenporn T, Tharavanij T. Incidences and outcomes of hyperglycemic crises: a 5-year study in a tertiary care center in Thailand. J Med Assoc Thai 2012;95:995-1002.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2024;105(4S):S117-S314.

Rattanawannee P. Diabetic ketoacidosis in adult patients. Nakhonphanom Hospital Journal 2021;8(2):5-14.

Niaz Z, Razzaq A, Chaudhary UJ, Awais M, Yaseen MA, Naseer I, et al. Mortality review of diabetic ketoacidosis in Mayo hospital, Lahore-Pakistan. Biomedica 2005;21:83-5.

Eledrisi MS, Alkabbani H, Aboawon M, Ali A, Alabdulrazzak I, Elhaj M, et al. Clinical characteristics and outcomes of care in patients hospitalized with diabetic ketoacidosis. Diabetes Res Clin Pract [Internet]. 2022 [cite 2024 July 16];192:110041. Available from: https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(22)00855-5/fulltext

Thewjitcharoen Y, Plianpan P, Chotjirat A, Nakasatien S, Chotwanvirat P, Wanothayaroj E, et al. Clinical characteristics and outcomes of care in adult patients with diabetic ketoacidosis: a retrospective study from a tertiary diabetes center in Thailand. J Clin Transl Endocrinol [Internet]. 2019 [cited 2024 July 16]:16:100188. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6462756/pdf/main.pdf

Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A. Diabetic ketoacidosis: clinical characteristics and precipitating factors. Cureus [Internet]. 2020 [cited 2024 July 17];12(10):e10792. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7606188/pdf/cureus-0012-00000010792.pdf

Ata F, Khan AA, Khamees I, Iqbal P, Yousaf Z, Mohammed BZM, et al. Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis. Ann Med 2023;55:533-42.

Thewjitcharoen Y, Sunthornyothin S. Clinical characteristics of diabetic ketoacidosis in newly diagnosed adult patients. Diabetes Res Clin Pract [Internet]. 2010 [cited 2024 July 17];90(2):e43-5. Available from: https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(10)00404-3/abstract

Vijara V, Polamaung W. Hyperglycemic crisis in Prapokklao hospital. J Prapokklao Hosp Clin Med Educat Center 2013;30:133-45.

Guisado-Vasco P, Cano-Megías M, Carrasco-de la Fuente M, Corres-González J, Matei AM, González-Albarrán O. 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. Endocrinol Nutr 2015;62:277-84.

Mekonnen GA, Gelaye KA, Gebreyohannes EA, Abegaz TM. Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. hospital-based study. PLoS One [Internet]. 2022 [cied 2024 Sep 3];17(4):e0264626. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8982884/pdf/pone.0264626.pdf