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Prognostic factors in hospitalized patients with diabetic ketoacidosis



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Prognostic factors in hospitalized patients with diabetic ketoacidosis


ZHANG Chunlin LIU Gang TONG Qiang ZHANG Rui

Department of Endocrinology, Department of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China


diabetic ketoacidosis Glasgow coma scale acute physiology and chronic health evaluation prognostic factors


Objective     To retrospectively analyze the prognostic factors for diabetic ketoacidsis (DKA) in order to improve the diagnosis and treatment and decreased the mortality for DKA. Methods     Clinical data of all DKA patients admitted in our department of endocrinology from January 2014 to December 2016 were collected and retrospectively analyzed. The patients were divided into the survival group and dead group. The baseline data, blood routine results, liver and renal functions, electrolyte levels, C-reactive protein (CRP) level, Scores of Glasgow coma scale (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ),and prognosis of the DKA patients were analyzed. Results     There were totally 70 subjects enrolled, including 36 males and 34 females, at an average age of 42.63±15.67 years. When compared with the dead group, the survival group had significantly higher GCS score (14.41±1.42 vs 11.36±3.14) and serum phosphate (0.96±0.47 vs 0.68±0.60 mg/L), but obviously lower APACHEⅡ score (8.58±4.63 vs 15.73±4.38), white blood cells count [(22.80±7.67)×109/L vs (14.82±9.55)×109/L], CRP level (211.39±173.93 vs 33.67±45.70 mg/L), serum creatinine (136.47±87.50 vs 87.28±43.89 μmol/L), and urea nitrogen (14.72±9.23 vs 8.45±5.00 mmol/L)(all P<0.05, P<0.01). The lower the GCS score was (OR=0.510, P<0.05) and the higher APACHEⅡ score (OR=1.300, P<0.05) and CRP level (OR=1.031, P<0.05) were, the worse the prognosis was in the DKA patients. Conclusion    CRP level, GCS score and APACHEⅡ score are independent prognostic factors for DKA patients.


[1]HIA D S, TARAI S G, ALIMI A, et al. Fluid management in pediatric patients with DKA and rates of suspected clinical cerebral edema[J]. Pediatr Diabetes, 2015, 16(5): 338-344. DOI: 10.1111/pedi.12268.
[2]DHATARIYA K K, NUNNEY I, HIGGINS K, et al. National survey of the management of Diabetic Ketoacidosis(DKA) in the UK in 2014[J]. Diabet Med, 2016, 33(2): 252-260. DOI: 10.1111/dme.12875.
[3]DELANEY M F, ZISMAN A, KETTYLE W M. Diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic syndrome[J]. En-docrinol Metab Clin North Am, 2000, 29(4): 683-705.
[4]UMPIERREZ G, KORYTKOWSKI M. Diabetic emergencies -ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia[J]. Nat Rev Endocrinol, 2016, 12(4): 222-232. DOI: 10.1038/nrendo.2016.15.
[5]中华医学会糖尿病学分会.中国高血糖危象诊断与治疗指南[J]. 中华糖尿病杂志, 2013, 5(8): 449-461.
Chinese Diabetes Society. Guidelines for diagnosis and therapy of hyperglycemic crisis in China[J]. Chin J Diabet Melli, 2013, 5(8): 449-461.
[6]BARSKI L, NEVZOROV R, HARMANBOEHM I, et al. Comparison of diabetic ketoacidosis in patients with type1 and type2 diabetes mellitus[J]. Am J Med Sci, 2013, 345(4): 326-330. DOI: 10.1097/MAJ.0b013e31827424ab.
[7]AZEVEDO L C, CHOI H, SIMMONDS K, et al. Incidence and long-term outcomes of critically ill adult patients with moderate-to-severe diabetic ketoacidosis: retrospective matched cohort study[J]. J Crit Care, 2014, 29(6): 971-977. DOI: 10.1016/j.jcrc.2014.07.034.
[8]VENKATESH B, PILCHER D, PRINS J, et al. Incidence and outcome of adults with diabetic ketoacidosis admitted to ICUs in Australia and New Zealand[J]. Critical Care, 2015, 19(1): 1-12. DOI: 10.1186/s13054-015-1171-7.
[9]AGARWAL A, YADAV A, GUTCH M, et al. Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis[J]. Endocrinol Metab (Seoul), 2016, 31(3): 424-432. DOI:10.3803/EnM.2016.31.3.424.
[10]SUWARTO S, SUTRISNA B, WASPADJI S, et al. Predictors of five days mortality in diabetic ketoacidosis patients: a prospective cohort study[J]. Acta Med Indones, 2014, 46(1): 18-23.
[11]方状盛, 赖树初. 53例糖尿病酮症酸中毒临床分析[J]. 中国医药科学, 2014, 4(15): 189-191. DOI: 10.3969/j.issn.2095- 0616. 2014.15.066.
FANG Z S, LAI S C. Clinical analysis of 53 cases of diabetic ketoacidosis[J]. China Med Pharm, 2014, 4(15): 189-191. DOI: 10.3969/j.issn.20950616. 2014.15.066.
[12]区敏, 周四光, 黄钰. 65例糖尿病酮症酸中毒的救治研究[J]. 中国医药指南, 2014, 12(33): 39-40.
OU M, ZHOU S G, HUANG Y. Emergency treatment  of 65 cases of diabetes mellitus ketoacidosis[J]. Guide China Med, 2014, 12(33): 39-40.
[13]NYENWE E A, KITABCHI A E. Evidencebased management of hyperglycemic emergencies in diabetes mellitus[J]. Diabetes Res Clin Pract, 2011, 94(3): 340-351. DOI: 10.1016/j.diabres.2011.09.012.
[14]NYENWE E A, KITABCHI A E. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management[J]. Metabolism, 2016, 65(4): 507-521. DOI: 10.1016/j.metabol.2015.12.007.
[15]GUISADO-VASCO P, CANO-MEG-AS M, CARRASCO-DE LA FUENTE M, et al. 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[J]. Endocrinol Nutr, 2015, 62(4): 277-284. DOI: 10.1016/j.endonu.2015.02.003.
[16]张宏兴. C反应蛋白与血常规联合检测在糖尿病酮症酸中毒合并感染患者中的研究分析[J]. 中国医药指南, 2012, 10(8): 107-108.
ZHANG H X. Analysis of C reactive protein and blood routine examination in patients with diabetic ketoacidosis complicated with infection[J]. Guide China Med, 2012, 10(8): 107-108.
[17]侯敬茹, 辛颖. 初发1型糖尿病患儿酮症酸中毒的影响因素分析[J]. 中华实用儿科临床杂志, 2015, 30(8): 585-588. DOI: 10.3760/cma.j.issn.2095428X.2015.08.006.
HOU J R, XIN Y. Analysis of influence factors of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes mellitus[J]. J App Clin Pediatr, 2015, 30(8): 585-588. DOI: 10.3760/cma.j.issn.2095-428X.2015.08.006.
[18]DALTON R R, HOFFMAN W H, PASSMORE G G, et al. Plasma CReactive Protein Levels in Severe Diabetic Ketoacidosis[J]. Ann Clin Lab Sci, 2003, 33(4): 435-442.
[19]KARAVANAKI K, KAKLEAS K, GEORGA S, et al. Plasma high sensitivity Creactive protein and its relationship with cytokine levels in children with newly diagnosed type 1 diabetes and ketoacidosis[J]. Clin Biochem, 2012, 45(16/17): 1383-1388. DOI: 10.1016/j.clinbiochem.2012.05.003.
[20]OTIENO C F, KAYIMA J K, MBUGUA P K, et al. Prognostic factors in patients hospitalised with diabetic ketoacidosis at Kenyatta National Hospital, Nairobi[J]. East Afr Med J, 2010, 87(2): 66-73.
[21]OWOLABI L, NAGODE M, IBRAHIM A, et al. Stroke in patients with diabetes mellitus: a study from North Western Nigeria[J]. Afr Health Sci, 2016, 16(3): 781-789.


Last Update: 2017-08-23