• Luciano C P Azevedo, Heidi Choi, Kim Simmonds, Jon Davidow, and Sean M Bagshaw.
• 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.
• J Crit Care. 2014 Dec 1;29(6):971-7.

ObjectiveThe 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.DesignThis is a retrospective matched cohort study.SettingThe settings are 2 tertiary teaching hospitals in Edmonton, Canada.PatientsPatients 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.InterventionsNone.Measurements And Main ResultsFrom 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.ConclusionsDiabetic 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.Copyright © 2014 Elsevier Inc. All rights reserved.

38 keywords...

hide…