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Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis.

by Amado X Freire, Guillermo E Umpierrez, Bekele Afessa, Kashif A Latif, Lisa Bridges, Abbas E Kitabchi
J Crit Care ()

Abstract

OBJECTIVE: To determine the predictive value for prolonged intensive\ncare unit (ICU) and hospital length of stay (LOS) in patients with\ndiabetic ketoacidosis (DKA) of the Acute Physiology and Chronic Health\nEvaluation II (APACHE II) score and Logistic Organ Dysfunction System\n(LODS), and to identify associated characteristics. DESIGN: Prospective\ncohort, 18-month observation. SUBJECTS AND SETTING: All admissions\nto a 12-bed, inner-city, university-affiliated hospital, medical\nICU from July 1999 to December 2000. MEASUREMENTS: Data for APACHE\nII and LODS scoring systems were collected within 24 hours of admission.\nLengths of ICU and hospital stay were the primary outcomes. Prolonged\nICU and hospital LOS were defined as 3 or more and 6 or more days.\nRESULTS: A total of 584 patients, mean age 49, 56% men, 82% African\nAmerican were admitted to the ICU. At admission they had (mean +/-SD)\nAPACHE II (18 +/- 10), LODS (5 +/- 4), and predicted mortality of\n32% +/- 29%. DKA was the admitting diagnosis in 42 (7.6%) patients;\nthey had lower APACHE II (12 +/- 6), LODS (2 +/- 1), and predicted\nmortality 5% +/- 5% than the general ICU population (all, P <.001).\nHospital mortality in non-DKA patients was 18%; there were no deaths\nin patients with DKA. Among DKA patients, those with insulin noncompliance\nhad a shorter hospital stay (2.8 +/- 1 d) than those with an underlying\nillness as the DKA trigger (4.8 +/- 3, P =.02). Between patients\nwith DKA, regardless of the LOS, there were no significant differences\nin APACHE II, LODS, or predicted mortality. CONCLUSIONS: ICU-admitted\npatients with DKA are less ill, and have lower disease severity scores,\nmortality, and shorter length of ICU and hospital stay than non-DKA\npatients. Disease severity scores are not, but precipitating cause\nis, predictor associated with prolonged hospital LOS in patients\nwith DKA.

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