Clinical and biochemical predictors of intensive care unit admission among patients with diabetic ketoacidosis

doi:10.4239/wjd.v14.i3.271

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World Journal of Diabetes

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World J Diabetes. Mar 15, 2023; 14(3): 271-278
Published online Mar 15, 2023. doi: 10.4239/wjd.v14.i3.271

Clinical and biochemical predictors of intensive care unit admission among patients with diabetic ketoacidosis

Adeel Ahmad Khan, Fateen Ata, Phool Iqbal, Mohammed Bashir, Anand Kartha

Adeel Ahmad Khan, Fateen Ata, Mohammed Bashir, Department of Endocrinology, Hamad Medical Corporation, Doha 00000, Qatar

Phool Iqbal, Department of Medicine, Metropolitan Hospital Center, New York, NY 10595, United States

Anand Kartha, Department of Medicine, Hamad Medical Corporation, Doha 00000, Qatar

Author contributions: Khan AA contributed to the study design, interpreted the data, and wrote the manuscript; Ata F conceptualized and designed the study, obtained ethical approval, and contributed to writing the manuscript; Iqbal P contributed to the acquisition of data and literature review; Bashir M and Kartha A are the co-last authors of the manuscript; Bashir M performed the statistical analysis and critically revised the manuscript’s content; Kartha A was the overall supervisor of the study and contributed to the study design and revision of the manuscript; all authors approved the final version of the article.

Institutional review board statement: The study was reviewed and approved by the Medical Research Center at Hamad Medical Corporation, Doha, Qatar with protocol (Approval No. MRC-01-21-476).

Informed consent statement: The requirement for participant informed consent was waived by the Medical Research Center (MRC) at Hamad Medical Corporation.

Conflict-of-interest statement: There are no conflicts of interest to report.

Data sharing statement: No additional data are available.

Corresponding author: Fateen Ata, MD, Doctor, Department of Endocrinology, Hamad Medical Corporation, 869 Street, Doha 00000, Qatar. docfateenata@gmail.com

Received: December 2, 2022
Peer-review started: December 2, 2022
First decision: January 3, 2023
Revised: January 13, 2023
Accepted: February 14, 2023
Article in press: February 14, 2023
Published online: March 15, 2023
Processing time: 102 Days and 16.9 Hours

ARTICLE HIGHLIGHTS

Research background

Diabetic ketoacidosis (DKA) is one of the most common acute complications of diabetes mellitus (DM). A significant number of DKA patients are admitted to the intensive care unit (ICU). However, not all DKA patients benefit from ICU admission.

Research motivation

To Identify patients who will benefit from ICU care is essential by looking into the factors that predict ICU admission in DKA patients.

Research objectives

To identify various risk factors that predict the requirement for ICU care in DKA patients.

Research methods

This is a retrospective cross-sectional study and included 922 adult patients with DKA. The study looked into the factors predicting ICU care requirements in DKA patients by logistic regression analysis.

Research results

DKA patients (25% of all) were admitted to ICU. Patients in the ICU were older, had a higher BMI, were of Asian origin, and had predominantly T2DM. Patients in the ICU group had a higher proportion of severe DKA (58.5% vs 36.6%). Infection (33.8%) was the most common trigger of DKA, followed by the new onset of DM (26.7%). ICU patients had higher markers of inflammation (WBC and CRP), a longer LOS, and longer DKA duration than those who did not require ICU care. Older age, T2DM, newly onset DM, an infectious trigger of DKA, moderate-severe DKA, concurrent NSTEMI, and COVID-19 infection are some factors that predict ICU requirement in a DKA patient.

Research conclusions

ICU admission rate in our DKA patients was lower than in other studies. Despite this, the overall mortality rate in our cohort was only 0.7%. Accurate identification of factors that predict ICU requirements in DKA patients can prevent unnecessary ICU bed occupancy and maintain a balance between cost-effectiveness and patient safety.

Research perspectives

Further studies are needed to look into the factors that might predict the need for ICU care at the time of presentation in DKA patients.