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Risk of death following admission to a UK hospital with diabetic ketoacidosis

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ABSTRACT

Aims/hypothesis: The aim of this study was to assess the risk of death during hospital admission for diabetic ketoacidosis (DKA) and, subsequently, following discharge. In addition, we aimed to characterise the risk factors for multiple presentations with DKA.

Methods: We conducted a retrospective cohort study of all DKA admissions between 2007 and 2012 at a university teaching hospital. All patients with type 1 diabetes who were admitted with DKA (628 admissions of 298 individuals) were identified by discharge coding. Clinical, biochemical and mortality data were obtained from electronic patient records and national databases. Follow-up continued until the end of 2014.

Results: Compared with patients with a single DKA admission, those with recurrent DKA (more than five episodes) were diagnosed with diabetes at an earlier age (median 14 [interquartile range 9–23] vs 24 [16–34] years, p < 0.001), had higher levels of social deprivation (p = 0.005) and higher HbA1c values (103 [89–108] vs 79 [66–96] mmol/mol; 11.6% [10.3–12.0%] vs 9.4% [8.2–10.9%], p < 0.001), and tended to be younger (25 [22–36] vs 31 [23–42] years, p = 0.079). Antidepressant use was greater in those with recurrent DKA compared with those with a single episode (47.5% vs 12.6%, p = 0.001). The inpatient DKA mortality rate was no greater than 0.16%. A single episode of DKA was associated with a 5.2% risk of death (4.1 [2.8–6.0] years of follow-up) compared with 23.4% in those with recurrent DKA admissions (2.4 [2.0–3.8] years of follow-up) (HR 6.18, p = 0.001).

Conclusions/interpretation: Recurrent DKA is associated with substantial mortality, particularly among young, socially disadvantaged adults with very high HbA1c levels.

Electronic supplementary material: The online version of this article (doi:10.1007/s00125-016-4034-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

No MeSH data available.


Kaplan–Meier curves stratified by lifetime DKA admissions. Blue line, single admission; green line, two to five admissions; red line, more than five admissions. Vertical lines indicate censored data
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Fig1: Kaplan–Meier curves stratified by lifetime DKA admissions. Blue line, single admission; green line, two to five admissions; red line, more than five admissions. Vertical lines indicate censored data

Mentions: Overall, 23.4% (15/64) of those with more than five lifetime DKA admissions died over a median 2.4 year (IQR 2.0–3.8 years) follow-up period (HR 6.18 [95% CI 2.1, 18.3], p = 0.001; Fig. 1). Death occurred in 13.5% (15/111) of those with two to five admissions (HR 3.02 [95% CI 1.1, 8.4; reference is single DKA], p = 0.035) over a median of 3.7 years (IQR 2.4–5.5 years). A single lifetime DKA admission was associated with a 5.2% (5/96) risk of death during the follow-up period (median 4.1 [IQR 2.8–6.0] years). Median age at death was significantly lower in those with more than five DKA admissions (32 [IQR 23–39] years) than in those with two to five admissions (median 53 [IQR 40–58] years) or a single admission (median 53 [IQR 38–66] years) (p = 0.014). The prevalence of cardiovascular disease was not independently associated with mortality. Multivariate analysis identified greater number of DKA admissions, longer diabetes duration, previous psychiatric admissions and older age at diagnosis as independent predictors of death (Table 3).Fig. 1


Risk of death following admission to a UK hospital with diabetic ketoacidosis
Kaplan–Meier curves stratified by lifetime DKA admissions. Blue line, single admission; green line, two to five admissions; red line, more than five admissions. Vertical lines indicate censored data
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5016550&req=5

Fig1: Kaplan–Meier curves stratified by lifetime DKA admissions. Blue line, single admission; green line, two to five admissions; red line, more than five admissions. Vertical lines indicate censored data
Mentions: Overall, 23.4% (15/64) of those with more than five lifetime DKA admissions died over a median 2.4 year (IQR 2.0–3.8 years) follow-up period (HR 6.18 [95% CI 2.1, 18.3], p = 0.001; Fig. 1). Death occurred in 13.5% (15/111) of those with two to five admissions (HR 3.02 [95% CI 1.1, 8.4; reference is single DKA], p = 0.035) over a median of 3.7 years (IQR 2.4–5.5 years). A single lifetime DKA admission was associated with a 5.2% (5/96) risk of death during the follow-up period (median 4.1 [IQR 2.8–6.0] years). Median age at death was significantly lower in those with more than five DKA admissions (32 [IQR 23–39] years) than in those with two to five admissions (median 53 [IQR 40–58] years) or a single admission (median 53 [IQR 38–66] years) (p = 0.014). The prevalence of cardiovascular disease was not independently associated with mortality. Multivariate analysis identified greater number of DKA admissions, longer diabetes duration, previous psychiatric admissions and older age at diagnosis as independent predictors of death (Table 3).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Aims/hypothesis: The aim of this study was to assess the risk of death during hospital admission for diabetic ketoacidosis (DKA) and, subsequently, following discharge. In addition, we aimed to characterise the risk factors for multiple presentations with DKA.

Methods: We conducted a retrospective cohort study of all DKA admissions between 2007 and 2012 at a university teaching hospital. All patients with type 1 diabetes who were admitted with DKA (628 admissions of 298 individuals) were identified by discharge coding. Clinical, biochemical and mortality data were obtained from electronic patient records and national databases. Follow-up continued until the end of 2014.

Results: Compared with patients with a single DKA admission, those with recurrent DKA (more than five episodes) were diagnosed with diabetes at an earlier age (median 14 [interquartile range 9–23] vs 24 [16–34] years, p < 0.001), had higher levels of social deprivation (p = 0.005) and higher HbA1c values (103 [89–108] vs 79 [66–96] mmol/mol; 11.6% [10.3–12.0%] vs 9.4% [8.2–10.9%], p < 0.001), and tended to be younger (25 [22–36] vs 31 [23–42] years, p = 0.079). Antidepressant use was greater in those with recurrent DKA compared with those with a single episode (47.5% vs 12.6%, p = 0.001). The inpatient DKA mortality rate was no greater than 0.16%. A single episode of DKA was associated with a 5.2% risk of death (4.1 [2.8–6.0] years of follow-up) compared with 23.4% in those with recurrent DKA admissions (2.4 [2.0–3.8] years of follow-up) (HR 6.18, p = 0.001).

Conclusions/interpretation: Recurrent DKA is associated with substantial mortality, particularly among young, socially disadvantaged adults with very high HbA1c levels.

Electronic supplementary material: The online version of this article (doi:10.1007/s00125-016-4034-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

No MeSH data available.