Fatima Samar, Rehman Naureen, Hashmi Muzna, Khan Aamna, Shahzaib Mohammad, Akram Muhammad Taha, Arshad Ainan
Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
Community Health Sciences, The Aga Khan University, Karachi, Pakistan
BMJ Open. 2025 Jul 30;15(7):e102173. doi: 10.1136/bmjopen-2025-102173.
The aim of this study was to evaluate protocol adherence and its impact on inpatient mortality in patients with diabetic ketoacidosis (DKA) at a tertiary hospital in Karachi. The major hypothesis was that adherence to the DKA protocol reduces inpatient mortality.
This was a retrospective cohort study.
The study was conducted at the Aga Khan University Hospital (AKUH), Karachi, a tertiary care hospital in Pakistan.
The study included patients diagnosed with DKA and admitted to AKUH from 2017 to 2021. Eligibility criteria included patients aged 18 and older, excluding those with incomplete records or referred to other hospitals.
The primary outcome was inpatient mortality. The analysis included Cox proportional hazards regression. Secondary outcome measures included predictors of mortality such as hypertension, intubation, tachycardia and elevated creatinine levels.
Non-compliance with the DKA protocol (<70%) was associated with a significantly higher inpatient mortality rate (p=0.003). Survival analysis revealed a shorter median survival time for patients with <70% compliance (15 days versus 19 days, p<0.05). Multivariable analysis showed that non-compliance was an independent risk factor for adverse events (adjusted HR 1.37 (95% CI 1.01 to 1.86), p=0.04). Hypertension, intubation, tachycardia and elevated creatinine levels were significantly associated with increased mortality risk.
Adherence to the DKA protocol is crucial for reducing inpatient mortality and improving outcomes, especially in low- and middle-income countries. Ensuring at least 70% compliance is vital. Recommendations include continuous training for healthcare providers, adequate staffing and resource optimisation. Future research should focus on interventions to boost compliance and explore other factors affecting protocol adherence to further enhance patient care.
本研究旨在评估卡拉奇一家三级医院中糖尿病酮症酸中毒（DKA）患者对治疗方案的依从性及其对住院死亡率的影响。主要假设是遵守DKA治疗方案可降低住院死亡率。
这是一项回顾性队列研究。
该研究在巴基斯坦卡拉奇的阿迦汗大学医院（AKUH）进行，这是一家三级护理医院。
该研究纳入了2017年至2021年期间被诊断为DKA并入住AKUH的患者。纳入标准包括年龄在18岁及以上的患者，不包括记录不完整或转诊至其他医院的患者。
主要结局是住院死亡率。分析包括Cox比例风险回归。次要结局指标包括死亡率的预测因素，如高血压、插管、心动过速和肌酐水平升高。
未遵守DKA治疗方案（<70%）与显著更高的住院死亡率相关（p=0.003）。生存分析显示，依从性<70%的患者中位生存时间较短（15天对19天，p<0.05）。多变量分析表明，不依从是不良事件的独立危险因素（调整后风险比1.37（95%置信区间1.01至1.86），p=0.04）。高血压、插管、心动过速和肌酐水平升高与死亡风险增加显著相关。
遵守DKA治疗方案对于降低住院死亡率和改善结局至关重要，尤其是在低收入和中等收入国家。确保至少70%的依从性至关重要。建议包括对医疗保健提供者进行持续培训、充足的人员配备和资源优化。未来的研究应侧重于提高依从性的干预措施，并探索影响方案依从性的其他因素，以进一步改善患者护理。
