CLINICAL CHARACTERISTICS AND TREATMENT OUTCOME OF DIABETIC KETOACIDOSIS AMONG DIABETIC PATIENTS ATDEBRETABOR GENERAL HOSPITAL, NORTH-WEST ETHIOPIA. A CROSS SECTIONAL STUDY

Abstract

Abstract

Background: Diabetic ketoacidosis is an acute life-threatening complication of diabetes mellitus. There was limited data on level of glycemic control, in hospital mortality, hospital stay and factors associated with length of hospital stay among diabetic patients admitted with diabetic ketoacidosis at Debretabor General Hospital. Objective: The aim of the study was to determine the clinical characteristics, the level of glycemic control length of hospital stay and in-hospital mortality of diabetic ketoacidosis patients and to assess determinants of long hospital stay among diabetic patients admitted with Diabetic ketoacidosis at Debretabor General Hospital

Method: A retrospective study was conducted at Debretabor General Hospital and data was collected from June 1 to 30, 2018. Participants included in the study were all diabetic patients with diabetic ketoacidosis admitted at Debretabor General Hospital from August 2010 to May 31, 2018with age ?15 years old whose medical records contained complete pertinent data. The primary outcome was to determine the level of glycemic control, the length of hospital stay and in-hospital mortality of diabetic ketoacidosis patients. All the statistical data was carried out using Statistical Package for Social Sciences (SPSS). Descriptive statistics was presented using means with standard deviation and percentages (%).

Result: A total of 682 patients were admitted with diabetic ketoacidosis at Debretabor general hospital from year August 2010 to May 31, 2018. Out of which 387 patients’ medical records contained pertinent complete information included in this study. Mean age of the patients was 33.30± 14.96 years ranging from 15-64 years. The majority of patients were females 244 (63.0%). The most common clinical presentation was polyuria and polydipsia in (n=379, 97.9%) of patients. The most common precipitating factors were new onset diabetes mellitus 150(38.8%). Mean length of hospital stay was 4.64(±2.802) days. There were 17 (4.4%) deaths. Mild and moderate DKA showed 84% and 83% reduction in the probability of long hospital stay than severe DKA; AOR: 0.16 [0.03-0.78] and AOR : 0.17[0.03-0.96] respectively . Age of 35-44 had 87.5% chance of reduction on long hospital stay than age of 55-64 years; AOR: 0.125 [0.017-0.92]. DKA precipitated by infection were 4.59 times more likely to have long hospital stay than DKA precipitated by unknown causes; AOR: 4.59 [1.08-19.42]. In addition, as the number of times the serum rebound glucose increase by one unit the likelihood of long hospital stay increased by more than 2.15 times ; AOR: 2.15[1.76-2.63]

Conclusions: In this study, newly 0nset type 1 diabetics were the major precipitating factor for DKA. Polyuria and polydipsia was the most common presenting clinical characteristic of diabetic ketoacidosis.

The mean length of hospital stay was 4.64 days in-hospital mortality was 4.4%; glycemic control was poor among patients admitted with DKA. Infection, number of times serum glucose rebound, age (between 35-44) and severity of diabetic ketoacidosis was determinants of long hospital stay.

Key word: Diabetic ketoacidosis, Clinical characteristics, long hospital stay