Endocr Pract. 2020 Jun 2;26(6):634-641. doi: 10.4158/EP-2019-0336. Epub 2020 Feb 11.
Weekend admission has been associated with higher morbidity and mortality, but the relationship between diabetic ketoacidosis (DKA) outcomes and this weekend effect is unclear. To better characterize it, we examined the outcomes of patients admitted with DKA to an urban tertiary-care center. This retrospective study included pediatric and adult patients admitted to Montefiore Health System from January 1, 2008, through December 31, 2018, with a primary or secondary diagnosis of DKA as identified by International Classification of Diseases (ICD)-9 and -10 codes; all ICD diagnoses were present on admission. Only the first admission for each patient was analyzed, and patients were excluded if their initial anion gap was less than 13 mEq/L. A subcohort comprised of patients with documented biochemical evidence of DKA resolution was also analyzed. The Friday-Saturday weekend was defined as the period between midnight on Friday and midnight on Sunday; the Saturday-Sunday weekend was similarly defined. The following outcomes were compared between weekday and weekend groups: length of stay; time to initiation of subcutaneous insulin; and time to each of the following: venous pH >7.3, blood glucose <200 mg/dL, and anion gap ≤12 mEq/L. Odds of 30-day all-cause mortality and 30-day all-cause and DKA-specific readmission were also examined. Over 11 years, 4,703 patients were included in the overall cohort, and 648 were included in the subcohort. For both weekend definitions, weekend admission did not produce differences in any outcome for either study cohort. No weekend effect on DKA outcomes was detected at an urban tertiary-care center. = anion gap; = Charlson Comorbidity Index; = diabetic ketoacidosis; = International Classification of Diseases; = intravenous insulin; = length of stay; = subcutaneous insulin.
周末入院与更高的发病率和死亡率相关，但糖尿病酮症酸中毒（DKA）结局与这种周末效应的关系尚不清楚。为了更好地描述这种关系，我们检查了在城市三级保健中心因 DKA 入院的患者的结局。这项回顾性研究包括 2008 年 1 月 1 日至 2018 年 12 月 31 日期间因 DKA 被收入蒙特菲奥雷健康系统的儿科和成人患者，主要或次要诊断由国际疾病分类（ICD）第 9 版和第 10 版代码确定；所有 ICD 诊断均在入院时存在。仅分析每位患者的首次入院，并且如果初始阴离子间隙小于 13 mEq/L，则排除患者。还分析了包含有记录的 DKA 缓解的生化证据的患者亚组。周五至周六周末被定义为周五午夜至周日午夜之间的时间段；周六至周日周末也以此类推。比较了工作日和周末组之间的以下结局：住院时间；开始皮下胰岛素的时间；以及静脉 pH 值>7.3、血糖<200 mg/dL 和阴离子间隙≤12 mEq/L 的时间。还检查了 30 天全因死亡率和 30 天全因和 DKA 特异性再入院的几率。在 11 年期间，纳入了 4703 名患者的总体队列，648 名患者纳入了亚组。对于这两种周末定义，周末入院在两个研究队列的任何结局上都没有差异。在城市三级保健中心没有发现 DKA 结局的周末效应。 =阴离子间隙； =Charlson 合并症指数； =糖尿病酮症酸中毒； =国际疾病分类； =静脉胰岛素； =住院时间； =皮下胰岛素。
