Luciano C P Azevedo1, Heidi Choi2, Kim Simmonds3, Jon Davidow4, Sean M Bagshaw5. 1. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-122 St, Edmonton, AB, T6G 2B7, Canada; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil; Emergency Medicine Department ICU, University of São Paulo, São Paulo, Brazil. 2. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-122 St, Edmonton, AB, T6G 2B7, Canada. 3. Infectious Disease Epidemiology, Surveillance and Assessment Branch, Community and Population Health Division, Alberta Health & Wellness, 23rd Floor, Telus Plaza NT 10025 Jasper Ave, Edmonton, Alberta, T5J 1S6, Canada. 4. Royal Alexandria Hospital, Division of Critical Care Medicine, Faculty of Medicine Dentistry, University of Alberta, 10240 Kingsway Ave NW, Edmonton, AB, T5H 3V9, Canada. 5. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-122 St, Edmonton, AB, T6G 2B7, Canada. Electronic address: bagshaw@ualberta.ca.
Abstract
OBJECTIVE: The objective of this study was to describe the clinical outcomes and treatment intensity of adult intensive care unit (ICU) patients with moderate-to-severe diabetic ketoacidosis (DKA). We aimed also to compare their clinical course with matched non-DKA ICU controls and to identify prognostic factors for mortality and hospital readmission within 1 year. DESIGN: This is a retrospective matched cohort study. SETTING: The settings are 2 tertiary teaching hospitals in Edmonton, Canada. PATIENTS: Patients were adults with moderate-to-severe DKA admitted from January 2002 to December 2009. Control patients were defined as randomly selected age, sex, and Acute Physiology and Chronic Health Evaluation II score-matched nondiabetic ICU patients (1:4.5 matching ratio). Diabetic patients were stratified according to severity of exacerbation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 2002 to 2009, the incidence of DKA per 1000 admissions was 4.59 (95% confidence interval [CI], 3.64-5.71). Severe DKA was associated with higher Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores in the first 3 days of ICU stay as compared with moderate DKA. Mechanical ventilation was received in 39%, vasopressors in 17%, and renal replacement therapy in 12% of DKA patients, respectively. One-year mortality and readmission rates were 9% and 36%. By logistic regression, death and/or readmission occurring in 1 year was independently associated with insulin use (odds ratio, 4.79; 95% CI, 1.14-20.05) and treatment noncompliance (odds ratio, 3.33; 95% CI, 1.04-10.64). Compared with matched non-DKA patients, those with DKA had lower mortality and were more likely to be discharged home. CONCLUSIONS: Diabetic ketoacidosis necessitating ICU admission is associated with considerable resource utilization and long-term risk for death. Interventions aimed to improve compliance with therapy may prevent readmissions and improve the long-term outcome.
OBJECTIVE: The objective of this study was to describe the clinical outcomes and treatment intensity of adult intensive care unit (ICU) patients with moderate-to-severe diabetic ketoacidosis (DKA). We aimed also to compare their clinical course with matched non-DKA ICU controls and to identify prognostic factors for mortality and hospital readmission within 1 year. DESIGN: This is a retrospective matched cohort study. SETTING: The settings are 2 tertiary teaching hospitals in Edmonton, Canada. PATIENTS: Patients were adults with moderate-to-severe DKA admitted from January 2002 to December 2009. Control patients were defined as randomly selected age, sex, and Acute Physiology and Chronic Health Evaluation II score-matched nondiabetic ICUpatients (1:4.5 matching ratio). Diabeticpatients were stratified according to severity of exacerbation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 2002 to 2009, the incidence of DKA per 1000 admissions was 4.59 (95% confidence interval [CI], 3.64-5.71). Severe DKA was associated with higher Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores in the first 3 days of ICU stay as compared with moderate DKA. Mechanical ventilation was received in 39%, vasopressors in 17%, and renal replacement therapy in 12% of DKA patients, respectively. One-year mortality and readmission rates were 9% and 36%. By logistic regression, death and/or readmission occurring in 1 year was independently associated with insulin use (odds ratio, 4.79; 95% CI, 1.14-20.05) and treatment noncompliance (odds ratio, 3.33; 95% CI, 1.04-10.64). Compared with matched non-DKA patients, those with DKA had lower mortality and were more likely to be discharged home. CONCLUSIONS:Diabetic ketoacidosis necessitating ICU admission is associated with considerable resource utilization and long-term risk for death. Interventions aimed to improve compliance with therapy may prevent readmissions and improve the long-term outcome.
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