Ramaesh Aksha
University of Edinburgh, Edinburgh, UK.
J Intensive Care Soc. 2016 Aug;17(3):222-233. doi: 10.1177/1751143716644458. Epub 2016 Apr 25.
Diabetic ketoacidosis is a life-threatening but avoidable complication of diabetes mellitus often managed in intensive care units. The risk of emergency hospital readmission in patients surviving an intensive care unit episode of diabetic ketoacidosis is unknown. We aimed to report the cumulative incidence of emergency hospital readmission and costs in all patients surviving an intensive care unit episode of diabetic ketoacidosis in Scotland.
We used a national six-year cohort of survivors of first diabetic ketoacidosis admissions to Scottish intensive care units (1 January 2005-31 December 2010) identified in the Scottish Intensive Care Society Audit Group registry linked to acute hospital and death records (follow-up censored 31 December 2010). Diabetic ketoacidosis-related emergency readmissions were identified using International Classification of Disease-10 codes.
During the study period, 386 patients were admitted to intensive care units in Scotland with diabetic ketoacidosis (admission rate 1.5/100,000 Scottish population). Median age was 44 (IQR 29-56); 51% male; 55% required no organ support on admission. Mortality after intensive care unit admission was 8% at 30 days, 18% at one year, and 35% at five years. A total of 349 patients survived their first intensive care unit diabetic ketoacidosis admission [mean (SD) age 42.5 (18.1) years; 50.4% women; 46.1% required ≥1 organ support]. Following hospital discharge, cumulative incidence of 90-day, one-year, and five-year diabetic ketoacidosis readmission (all-cause readmission) was 13.8% (31.8%), 29.7% (58.9%) and 46.4% (82.6%).
Diabetic ketoacidosis in patients requiring intensive care unit admission is associated with high risk of long-term mortality and high hospital costs. An understanding of the precipitating causes of diabetic ketoacidosis in patients admitted to intensive care units may allow patients who are at high risk to be targeted, potentially reducing future morbidity and the substantial burden that diabetic ketoacidosis currently places on the healthcare system.
糖尿病酮症酸中毒是糖尿病一种危及生命但可避免的并发症，常在重症监护病房进行治疗。糖尿病酮症酸中毒患者在重症监护病房治疗后急诊再次入院的风险尚不清楚。我们旨在报告苏格兰所有糖尿病酮症酸中毒患者在重症监护病房治疗后急诊再次入院的累积发生率及费用情况。
我们使用了一个全国性的六年队列，该队列包含首次因糖尿病酮症酸中毒入住苏格兰重症监护病房的幸存者（2005年1月1日至2010年12月31日），这些患者信息来自苏格兰重症监护学会审计组登记处，并与急性医院和死亡记录相关联（随访截止于2010年12月31日）。使用国际疾病分类第10版编码来识别与糖尿病酮症酸中毒相关的急诊再次入院情况。
在研究期间，386例糖尿病酮症酸中毒患者入住苏格兰重症监护病房（入院率为每10万苏格兰人口中有1.5例）。中位年龄为44岁（四分位间距29 - 56岁）；51%为男性；55%入院时无需器官支持。重症监护病房入院后30天死亡率为8%，一年时为18%，五年时为35%。共有349例患者在首次重症监护病房糖尿病酮症酸中毒入院后存活[平均（标准差）年龄42.5（18.1）岁；50.4%为女性；46.1%需要≥1种器官支持]。出院后，90天、一年和五年糖尿病酮症酸中毒再次入院（全因再次入院）的累积发生率分别为13.8%（31.8%）、29.7%（58.9%）和46.4%（82.6%）。
需要入住重症监护病房的糖尿病酮症酸中毒患者存在长期死亡的高风险和高昂的医院费用。了解入住重症监护病房的糖尿病酮症酸中毒患者的诱发原因，可能有助于针对高危患者，从而有可能降低未来的发病率以及糖尿病酮症酸中毒目前给医疗系统带来的沉重负担。
