Taye Getu Melesie, Bacha Amente Jorise, Taye Fetene Abeje, Bule Mohammed Hussen, Tefera Gosaye Mekonen
Department of Pharmacy, Pharmacology Unit, Ambo University, Ambo, Ethiopia.
Department of Pharmacy, Clinical Pharmacy Unit, Ambo University, Ambo, Ethiopia.
Clin Med Insights Endocrinol Diabetes. 2021 Apr 12;14:11795514211004957. doi: 10.1177/11795514211004957. eCollection 2021.
Diabetic Ketoacidosis (DKA) is the most common and yet potentially life-threatening acute complication of diabetes that progresses rapidly to death and requires immediate medical intervention.
To assess the DKA management and treatment outcome/in-hospital mortality and its predictors among hospitalized patients with DKA at the Medical ward of Shashemene Referral Hospital (SRH).
A retrospective study was conducted at the Medical Ward of SRH from 01 February 2015 to 31 January 2017. A systematic random sampling technique was used to select study subjects based on the inclusion criteria. Thus, of 236 reviewed charts, only 225 patients with DKA fulfilled inclusion criteria. Treatment outcome was considered good for patients who have shown improvement at discharge, while poor for patients who left against medical advice or died in the hospital. Logistic regression analysis was done to determine independent predictors for treatment outcome/in-hospital mortality using SPSS version 20 with statistical significant at ⩽ .05.
Of 225 patients with DKA, 124 (55.1%) were male. Regular insulin was prescribed to all patients and antibiotics were administered to 87 (38.7%). Potassium supplementation was given only for 28 (12.4%). Non-adherence to insulin treatment (n = 91; 40.4%) and infection (n = 66; 29.3%) were the principal DKA precipitating factors. Even though 73.8% of hospitalized patients with DKA have shown good treatment outcomes, DKA contributed 12% in-hospital mortality. The result of multivariate logistic regression analysis shown that hypoglycemia is the only independent predictor for in-hospital mortality[ = .03]. Moreover, the independent predictors for poor DKA treatment outcome were found to be smoker [ = .04], Urinary tract infection (UTI) relative to other co-morbid condition [ < .001], severe hypokalemia which increase risk of poor treatment outcome by around 4 times [ = .02], and use of Metronidazole as a concurrent medication relative to other concurrent medication [ = .03].
There was a high in-hospital mortality rate due to correctable causes. This mortality is unacceptable as it was majorly related to the poor practice of potassium supplementation and hypoglycemia due to insulin. Thus, clinicians and stakeholders should have to focus on modifiable factors (hypokalemia, UTI, and hypoglycemia) to reduce poor treatment outcome/in-hospital mortality.
糖尿病酮症酸中毒（DKA）是糖尿病最常见且可能危及生命的急性并发症，病情发展迅速可导致死亡，需要立即进行医学干预。
评估在沙舍梅内转诊医院（SRH）内科病房住院的DKA患者的DKA管理及治疗结局/院内死亡率及其预测因素。
于2015年2月1日至2017年1月31日在SRH内科病房进行一项回顾性研究。采用系统随机抽样技术根据纳入标准选择研究对象。因此，在236份审查病历中，只有225例DKA患者符合纳入标准。对于出院时病情有所改善的患者，治疗结局被视为良好；对于违反医嘱离开或在医院死亡的患者，治疗结局被视为不佳。使用SPSS 20版进行逻辑回归分析，以确定治疗结局/院内死亡率的独立预测因素，检验水准为α≤0.05。
225例DKA患者中，124例（55.1%）为男性。所有患者均使用了正规胰岛素，87例（38.7%）使用了抗生素。仅28例（12.4%）患者补钾。不遵医嘱进行胰岛素治疗（n = 91；40.4%）和感染（n = 66；29.3%）是DKA的主要诱发因素。尽管73.8%的住院DKA患者治疗结局良好，但DKA导致了12%的院内死亡率。多因素逻辑回归分析结果显示，低血糖是院内死亡率的唯一独立预测因素[P = 0.03]。此外，发现DKA治疗结局不佳的独立预测因素为吸烟者[P = 0.04]、与其他合并症相比的尿路感染（UTI）[P < 0.001]、严重低钾血症使治疗结局不佳的风险增加约4倍[P = 0.02]，以及与其他联合用药相比使用甲硝唑作为联合用药[P = 0.03]。
因可纠正原因导致的院内死亡率较高。这种死亡率是不可接受的，因为它主要与补钾措施不力以及胰岛素导致的低血糖有关。因此，临床医生和利益相关者应关注可改变的因素（低钾血症、UTI和低血糖），以减少不佳的治疗结局/院内死亡率。
