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Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis.
J Crit Care 2002; 17(4):207-11JC

Abstract

OBJECTIVE

To determine the predictive value for prolonged intensive care unit (ICU) and hospital length of stay (LOS) in patients with diabetic ketoacidosis (DKA) of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Logistic Organ Dysfunction System (LODS), and to identify associated characteristics.

DESIGN

Prospective cohort, 18-month observation.

SUBJECTS AND SETTING

All admissions to a 12-bed, inner-city, university-affiliated hospital, medical ICU from July 1999 to December 2000.

MEASUREMENTS

Data for APACHE II and LODS scoring systems were collected within 24 hours of admission. Lengths of ICU and hospital stay were the primary outcomes. Prolonged ICU and hospital LOS were defined as 3 or more and 6 or more days.

RESULTS

A total of 584 patients, mean age 49, 56% men, 82% African American were admitted to the ICU. At admission they had (mean +/-SD) APACHE II (18 +/- 10), LODS (5 +/- 4), and predicted mortality of 32% +/- 29%. DKA was the admitting diagnosis in 42 (7.6%) patients; they had lower APACHE II (12 +/- 6), LODS (2 +/- 1), and predicted mortality 5% +/- 5% than the general ICU population (all, P <.001). Hospital mortality in non-DKA patients was 18%; there were no deaths in patients with DKA. Among DKA patients, those with insulin noncompliance had a shorter hospital stay (2.8 +/- 1 d) than those with an underlying illness as the DKA trigger (4.8 +/- 3, P =.02). Between patients with DKA, regardless of the LOS, there were no significant differences in APACHE II, LODS, or predicted mortality.

CONCLUSIONS

ICU-admitted patients with DKA are less ill, and have lower disease severity scores, mortality, and shorter length of ICU and hospital stay than non-DKA patients. Disease severity scores are not, but precipitating cause is, predictor associated with prolonged hospital LOS in patients with DKA.

Authors+Show Affiliations

Department of Medicine, the University of Tennessee Health Sciences Center, Memphis, TN 38163, USA. afreire@utmem.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12501147

Citation

Freire, Amado X., et al. "Predictors of Intensive Care Unit and Hospital Length of Stay in Diabetic Ketoacidosis." Journal of Critical Care, vol. 17, no. 4, 2002, pp. 207-11.
Freire AX, Umpierrez GE, Afessa B, et al. Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. J Crit Care. 2002;17(4):207-11.
Freire, A. X., Umpierrez, G. E., Afessa, B., Latif, K. A., Bridges, L., & Kitabchi, A. E. (2002). Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. Journal of Critical Care, 17(4), pp. 207-11.
Freire AX, et al. Predictors of Intensive Care Unit and Hospital Length of Stay in Diabetic Ketoacidosis. J Crit Care. 2002;17(4):207-11. PubMed PMID: 12501147.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. AU - Freire,Amado X, AU - Umpierrez,Guillermo E, AU - Afessa,Bekele, AU - Latif,Kashif A, AU - Bridges,Lisa, AU - Kitabchi,Abbas E, PY - 2002/12/26/pubmed PY - 2003/3/18/medline PY - 2002/12/26/entrez SP - 207 EP - 11 JF - Journal of critical care JO - J Crit Care VL - 17 IS - 4 N2 - OBJECTIVE: To determine the predictive value for prolonged intensive care unit (ICU) and hospital length of stay (LOS) in patients with diabetic ketoacidosis (DKA) of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Logistic Organ Dysfunction System (LODS), and to identify associated characteristics. DESIGN: Prospective cohort, 18-month observation. SUBJECTS AND SETTING: All admissions to a 12-bed, inner-city, university-affiliated hospital, medical ICU from July 1999 to December 2000. MEASUREMENTS: Data for APACHE II and LODS scoring systems were collected within 24 hours of admission. Lengths of ICU and hospital stay were the primary outcomes. Prolonged ICU and hospital LOS were defined as 3 or more and 6 or more days. RESULTS: A total of 584 patients, mean age 49, 56% men, 82% African American were admitted to the ICU. At admission they had (mean +/-SD) APACHE II (18 +/- 10), LODS (5 +/- 4), and predicted mortality of 32% +/- 29%. DKA was the admitting diagnosis in 42 (7.6%) patients; they had lower APACHE II (12 +/- 6), LODS (2 +/- 1), and predicted mortality 5% +/- 5% than the general ICU population (all, P <.001). Hospital mortality in non-DKA patients was 18%; there were no deaths in patients with DKA. Among DKA patients, those with insulin noncompliance had a shorter hospital stay (2.8 +/- 1 d) than those with an underlying illness as the DKA trigger (4.8 +/- 3, P =.02). Between patients with DKA, regardless of the LOS, there were no significant differences in APACHE II, LODS, or predicted mortality. CONCLUSIONS: ICU-admitted patients with DKA are less ill, and have lower disease severity scores, mortality, and shorter length of ICU and hospital stay than non-DKA patients. Disease severity scores are not, but precipitating cause is, predictor associated with prolonged hospital LOS in patients with DKA. SN - 0883-9441 UR - https://www.unboundmedicine.com/medline/citation/12501147/Predictors_of_intensive_care_unit_and_hospital_length_of_stay_in_diabetic_ketoacidosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883944102500034 DB - PRIME DP - Unbound Medicine ER -