Alotaibi Abdulaziz, Aldoukhi Abdulrahman, Albdah Bayan, Alonazi Jamila A, Alseraya Amjad S, Alrasheed Najla
Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.
Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, SAU.
Cureus. 2020 Aug 27;12(8):e10067. doi: 10.7759/cureus.10067.
Background Diabetic ketoacidosis (DKA) is a life-threatening condition with high morbidity and mortality rates. It should be diagnosed immediately and managed intensively to prevent its significant complications. Objectives The aim of this study to assess DKA treatment outcome and associated factors among adult patients at King Abdulaziz Medical City Emergency Department and Medical Wards, Riyadh, Saudi Arabia. Materials and Methods A retrospective cross-sectional study was conducted using a chart review to assess DKA treatment outcome and associated factors. All patients who were admitted as DKA cases from September 2017 to August 2019 were selected by simple random sampling except those with incomplete charts or younger than 14 years. Data were entered and analyzed using SAS Version 9.4 (SAS Institute, Cary, NC, USA). Results A total of 223 reviewed charts were collected. The frequency of DKA recurrence in most of the patients was once per year (126 [56.5%]). The most common precipitating factor was inappropriate insulin therapy (104 [46.64%]). More than half of the patients (120 [53.81%]) got out of DKA management protocol within 24-72 hours with a hospital stay of less than or equal to five days. The mortality rate was 1.83%. Patients with two or more DKA episodes per year tended to be admitted to ICU more frequently than those with one episode (p=0.001). It was found that patients who had a duration of one to five years of diabetes mellitus were almost five times more likely to get out of DKA in more than 72 hours when compared with those who had a duration of more than five years (adjusted OR: 4.7; 95% CI: 1.34-16.60; p=0.01). Conclusions The findings of this study highlight that majority of DKA patients showed improvement and discharged with a very low mortality rate. Inappropriate insulin therapy was the most common precipitating factor; thus, educating diabetic patients about the complications of treatment non-compliance is an important part of management.
糖尿病酮症酸中毒（DKA）是一种危及生命的疾病，发病率和死亡率都很高。应立即诊断并进行强化治疗，以预防其严重并发症。目的：本研究旨在评估沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城急诊科和内科病房成年患者的DKA治疗结果及相关因素。材料与方法：采用回顾性横断面研究，通过病历审查评估DKA治疗结果及相关因素。除病历不完整或年龄小于14岁的患者外，采用简单随机抽样法选取2017年9月至2019年8月期间所有以DKA病例入院的患者。使用SAS 9.4版软件（美国北卡罗来纳州卡里市SAS研究所）录入和分析数据。结果：共收集到223份经审查的病历。大多数患者DKA复发频率为每年一次（126例[56.5%]）。最常见的诱发因素是胰岛素治疗不当（104例[46.64%]）。超过一半的患者（120例[53.81%]）在24至72小时内脱离DKA治疗方案，住院时间小于或等于5天。死亡率为1.83%。每年发生两次或更多次DKA发作的患者比发作一次的患者更频繁地入住重症监护病房（p = 0.001）。研究发现，糖尿病病程为1至5年的患者在72小时以上脱离DKA的可能性几乎是病程超过5年患者的五倍（校正比值比：4.7；95%置信区间：1.34 - 16.60；p = 0.01）。结论：本研究结果表明，大多数DKA患者病情好转并出院，死亡率极低。胰岛素治疗不当是最常见的诱发因素；因此，对糖尿病患者进行治疗不依从并发症的教育是管理的重要组成部分。
