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Respiratory Care |

Outcome of Patients With Diabetic Ketoacidosis and Acute Respiratory Failure FREE TO VIEW

Suresh Kumar Manickavel; Tapan Pandya; Natasha Adlakha, BA; Anam Bashir; Jacob Mathew; Ayham Aboeed; Muhammad Khan
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St Joseph's Regional Medical Center, Paterson, NJ


Chest. 2014;146(4_MeetingAbstracts):903A. doi:10.1378/chest.1995087
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Abstract

SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Diabetic ketoacidosis (DKA) is a life threatening metabolic derangement. Acute respiratory failure in DKA is a strong mortality predictor and is usually secondary to both a decreased level of consciousness and severe acidosis. We assessed the outcome of patients admitted with DKA and acute respiratory failure.

METHODS: A retrospective cohort analysis was done on patients admitted to our hospital with DKA and acute respiratory failure between January 2008 and December 2013. The baseline demographic information, clinical and laboratory characteristics were collected. The primary outcome of the study was in-hospital mortality. A univariate analysis was done to identify association of variables with the outcome. Continuous variables were reported as mean (SD) and compared via the student t test. Comparison of categorical data was made via the chi-square test.

RESULTS: The cohort consisted of 76 patients admitted with diabetic ketoacidosis and acute respiratory failure. Of these patients, 28 deaths were noted resulting in a mortality rate of 37%. On univariate analysis, the presence of shock on admission and infection were significantly associated with mortality with a p value of 0.004 and 0.03 respectively. Pneumonia was the cause of death in 9 patients (32%). The potential of hydrogen (pH) was not statistically associated with mortality {Alive 7.12 vs dead 7.15; p value 0.42}, while the anion gap was statistically lower in patients who died {Dead 21.4 vs. alive 27; p value 0.001}.

CONCLUSIONS: Mortality rate for diabetic ketoacidosis has significantly decreased with insulin therapy, however, patients with acute respiratory failure and altered mental status have a higher mortality risk. In this study, we assessed the factors that may contribute to mortality in a subset of patients with respiratory failure. Infection and shock were the causes for a majority of deaths in our cohort. Severity of acidosis did not appear to affect the outcome.

CLINICAL IMPLICATIONS: Further studies may help to establish if empirical antibiotics in diabetic ketoacidosis decrease mortality in high-risk patients on admission.

DISCLOSURE: The following authors have nothing to disclose: Suresh Kumar Manickavel, Tapan Pandya, Natasha Adlakha, Anam Bashir, Jacob Mathew, Ayham Aboeed, Muhammad Khan

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