Khan AA, Ata F, Iqbal P, Bashir M, Kartha A. Clinical and biochemical predictors of intensive care unit admission among patients with diabetic ketoacidosis. World J Diabetes 2023; 14(3): 271-278 [PMID: 37035234 DOI: 10.4239/wjd.v14.i3.271]
Corresponding Author of This Article
Fateen Ata, MD, Doctor, Department of Endocrinology, Hamad Medical Corporation, 869 Street, Doha 00000, Qatar. docfateenata@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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
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.
