title: Can APACHE II Score Predict Diabetic Ketoacidosis in Hyperglycemic Patients Presenting to Emergency Department?
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) is an acute and life-threatening complication in diabetic patients. The current diagnostic criteria of DKA are metabolic acidosis, blood glucose level greater than 250 mg/dL and the presence of ketones in serum or urine. DKA patients referring to the emergency department (ED) are usually ill.
  
  
  OBJECTIVE
  The present study aims to evaluate the efficacy of Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring in predicting the critically illness in the hyperglycemic patients referring to the ED.
  
  
  METHODS
  We performed a prospective cohort study in an ED. One hundred eighty one patients older than 18 years with hyperglycemia were included in our study. Following the primary evaluation, the subjects were divided into DKA and non-DKA patients. APACHE II scores were calculated for all patients and then compared to each other. We determined predictive value, sensitivity, specificity and cut-off points of APACHE II score for DKA.
  
  
  RESULTS
  Sixty two patients had DKA. The comparison of APACHE II score among two groups of the patients did not show any significant difference (P = 0.597). There was no suitable cut-off point for APACHE II score to predict DKA.
  
  
  CONCLUSIONS
  APACHE II score cannot be applied in the predicting of DKA in hyperglycemic patients admitted in ED.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Saeid
authors.initials: S
authors.lastname: Safari
authors.affiliation: Emergency Medicine Department, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Farzad
authors.initials: F
authors.lastname: Rahmani
authors.affiliation: Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Soleimanpour
authors.affiliation: Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Hanieh
authors.initials: H
authors.lastname: Ebrahimi Bakhtavar
authors.affiliation: Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Robab
authors.initials: R
authors.lastname: Mehdizadeh Esfanjani
keywords: APACHE II; Diabetic Ketoacidosis; Emergency Department