Sebastian-Valles Fernando, Von Wernitz Teleki Andrés Carlos, Tapia-Sanchiz Maria Sara, Navas-Moreno Victor, Lopez-Ruano Marta, Martinez-Otero Carmen, Carrillo-López Elena, Sager-La Ganga Carolina, Raposo-López Juan José, Amar Selma, Castañar Sara González, Arranz-Martin Jose Alfonso, Del Arco Carmen, Marazuela Mónica
Department of Endocrinology and Nutrition, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), C/Diego de Leon 62, 28006, Madrid, Spain.
Emergency Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
Acta Diabetol. 2024 Dec 16. doi: 10.1007/s00592-024-02421-y.
The objective of this study was to develop a predictive model capable of determining the need for intensive care unit (ICU) admission of patients with diabetic ketoacidosis (DKA) during their assessment in the Emergency Department.
This is an observational study of consecutive cases including all adult patients diagnosed with DKA at a tertiary hospital between 2010 and 2024. Variables from medical history, physical examination, and laboratory tests at admission were collected and studied for their association with ICU admission. The sample was divided into two randomized parts: one to build a logistic regression model and another to validate it.
Two hundred and thirty-one DKA events were included. Individuals had a mean age of 49.6 ± 19.9 years and 50.2% were male. Forty-eight point five percent of cases required ICU admission, and 30-day mortality was 4.8%. The best model to predict ICU admission included Glasgow Coma Scale (odds ratio [OR] = 0.64, p = 0.003), pH (OR = 0.0088, p = 0.005), bilirubin (OR = 0.13, p = 0.036), bicarbonate (OR = 0.0091, p = 0.013), and pH-bicarbonate interaction (OR = 3.78, p = 0.015). The model had an R of 0.561, and the area under the curve (AUC) in the validation cohort was 0.842. Internal validation by bootstrap resampling showed an AUC = 0.871.
Variables associated with the severity of acidosis in patients with DKA predict the need for ICU admission better and earlier than other clinical variables.
本研究的目的是开发一种预测模型，能够在急诊科对糖尿病酮症酸中毒（DKA）患者进行评估时确定其是否需要入住重症监护病房（ICU）。
这是一项对连续病例的观察性研究，纳入了2010年至2024年期间在一家三级医院诊断为DKA的所有成年患者。收集入院时病史、体格检查和实验室检查的变量，并研究它们与入住ICU的相关性。样本被随机分为两部分：一部分用于建立逻辑回归模型，另一部分用于验证该模型。
共纳入231例DKA事件。患者的平均年龄为49.6±19.9岁，50.2%为男性。48.5%的病例需要入住ICU，30天死亡率为4.8%。预测入住ICU的最佳模型包括格拉斯哥昏迷量表（优势比[OR]=0.64，p=0.003）、pH值（OR=0.0088，p=0.005）、胆红素（OR=0.13，p=0.036）、碳酸氢盐（OR=0.0091，p=0.013）以及pH值与碳酸氢盐的相互作用（OR=3.78，p=0.015）。该模型的R值为0.561，验证队列中的曲线下面积（AUC）为0.842。通过自助重采样进行的内部验证显示AUC=0.871。
与DKA患者酸中毒严重程度相关的变量比其他临床变量能更好、更早地预测入住ICU的需求。
