Predicting diabetic ketoacidosis severity score: proposal of a therapeutic strategy adapted to emergency department

Houda Ben Soltane, Marwa Talbi , Mariem Khrouf, Ahmed Guesmi, Zied Mezgar, Mehdi Methamem.

Résumé

Background: We investigated independent severity predictors of diabetic ketoacidosis and developed a prediction rule for emergency physicians to classify patients into severity groups.
Methods: This study was done in a university-affiliated medical center. Consecutive adult patients (>15 years old) visiting the emergency department (ED) between July 2016 and July 2018 were enrolled when they met the criteria of DKA. Hospitalization in an intensive care setting was the primary endpoint.
Results: We included 176 patients diagnosed with DKA in the ED. We found 7 independent severity predictors: Altered mental status, venous pH, bicarbonate level, blood glucose, Serum creatinine, H4 serum chloremia and effective serum osmolality at admission. After assigning weights to each predictor, we developed a predicting DKA severity score that stratifies patients into groups: low severity (score<3): treatment in a general ward or the ED; and high (score≥3): treatment in the ICU. The area under the curve for the rule was 0.863.
Conclusions: The score is a simple and rapid rule for predicting severity and classifying patients with DKA.