title: Incidence and long-term outcomes of critically ill adult patients with moderate-to-severe diabetic ketoacidosis: retrospective matched cohort study.
abstract: OBJECTIVE
  The objective of this study was to describe the clinical outcomes and treatment intensity of adult intensive care unit (ICU) patients with moderate-to-severe diabetic ketoacidosis (DKA). We aimed also to compare their clinical course with matched non-DKA ICU controls and to identify prognostic factors for mortality and hospital readmission within 1 year.
  
  
  METHODS
  This is a retrospective matched cohort study.
  
  
  METHODS
  The settings are 2 tertiary teaching hospitals in Edmonton, Canada.
  
  
  METHODS
  Patients were adults with moderate-to-severe DKA admitted from January 2002 to December 2009. Control patients were defined as randomly selected age, sex, and Acute Physiology and Chronic Health Evaluation II score-matched nondiabetic ICU patients (1:4.5 matching ratio). Diabetic patients were stratified according to severity of exacerbation.
  
  
  METHODS
  None.
  
  
  RESULTS
  From 2002 to 2009, the incidence of DKA per 1000 admissions was 4.59 (95% confidence interval [CI], 3.64-5.71). Severe DKA was associated with higher Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores in the first 3 days of ICU stay as compared with moderate DKA. Mechanical ventilation was received in 39%, vasopressors in 17%, and renal replacement therapy in 12% of DKA patients, respectively. One-year mortality and readmission rates were 9% and 36%. By logistic regression, death and/or readmission occurring in 1 year was independently associated with insulin use (odds ratio, 4.79; 95% CI, 1.14-20.05) and treatment noncompliance (odds ratio, 3.33; 95% CI, 1.04-10.64). Compared with matched non-DKA patients, those with DKA had lower mortality and were more likely to be discharged home.
  
  
  CONCLUSIONS
  Diabetic ketoacidosis necessitating ICU admission is associated with considerable resource utilization and long-term risk for death. Interventions aimed to improve compliance with therapy may prevent readmissions and improve the long-term outcome.
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-122 St, Edmonton, AB, T6G 2B7, Canada; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil; Emergency Medicine Department ICU, University of São Paulo, São Paulo, Brazil.
authors.forename: Luciano C P
authors.initials: LC
authors.lastname: Azevedo
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-122 St, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Heidi
authors.initials: H
authors.lastname: Choi
authors.affiliation: Infectious Disease Epidemiology, Surveillance and Assessment Branch, Community and Population Health Division, Alberta Health & Wellness, 23rd Floor, Telus Plaza NT 10025 Jasper Ave, Edmonton, Alberta, T5J 1S6, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Simmonds
authors.affiliation: Royal Alexandria Hospital, Division of Critical Care Medicine, Faculty of Medicine Dentistry, University of Alberta, 10240 Kingsway Ave NW, Edmonton, AB, T5H 3V9, Canada.
authors.forename: Jon
authors.initials: J
authors.lastname: Davidow
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-122 St, Edmonton, AB, T6G 2B7, Canada. Electronic address: bagshaw@ualberta.ca.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D016022:Case-Control Studies; D016638:Critical Illness; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010359:Patient Readmission; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Diabetes mellitus; Diabetic ketoacidosis; Insulin; Intensive care unit; Mortality; Resource utilization