E. Oschatz, M. Müllner, H. Herkner and AN. Laggner (1999). Multiple organ failure and prognosis in adult patients with diabetic ketoacidosis. Wiener klinische Wochenschrift, 111(15), 590-5.

PubMed 10483673

[Abstract]
OBJECTIVE: Evaluation of prognostic factors of patients presenting with diabetic ketoacidosis (DKA) at an emergency department.

DESIGN: Retrospective cohort study.

SETTING: The Emergency Department of the Vienna General Hospital, a 2000-bed tertiary care hospital.

PATIENTS AND PARTICIPANTS: Patients with DKA admitted from January 1, 1994 to September 30, 1998.

INTERVENTIONS: Treatment of DKA in accordance with a predefined regimen.

MEASUREMENTS AND RESULTS: History, clinical findings, biochemical parameters, blood gas analysis, multiorgan failure score (MOF) and treatment modalities were assessed. Patients were followed until death or hospital discharge. For group comparison the Mann Whitney U-test was used. Within the study period 21 patients were admitted because of diabetic ketoacidosis (female: 10, median age: 42 years; 31 to 58). All patients suffered from insulin-dependent diabetes mellitus and were treated according to a standardised protocol. Six patients (29%) died in hospital. The non-survivors had significantly higher MOF-scores on admission (5 vs. 2, p < 0.001) and after 24 hours (4 vs. 0, p < 0.01) of intensive care treatment. Additionally, non-survivors had significantly higher levels of GOT (64 vs. 8 U/l), GPT (28 vs. 11 U/l), BUN (34.63 vs. 12.14 mmol/l), creatinine (291.7 vs. 150.3 mmol/l), amylase (315 vs. 78 U/l) and lipase (573 vs. 122 U/l) on admission than did survivors (p < 0.05), and also had a significantly higher net positive fluid balance after 24 hours (8.0 vs. 4.75 l, p < 0.05). All other parameters were not significantly different between the groups.

CONCLUSION: Multiple organ failure may develop in patients with diabetic ketoacidosis and is associated with poor prognosis.