The effect of blood gas analysis and Charlson comorbidity index evaluation on the prediction of hospitalization period in patients with diabetic hyperglycemic crisis

Year 2021, , 698 - 702, 05.09.2021

Nihat Mujdat Hokenek Rohat Ak

https://doi.org/10.32322/jhsm.953157

Abstract

Objective: This study aims to evaluate the effectiveness of blood gas analysis at the time of admission and additional Charlson comorbidity index (CCI) in predicting the hospitalization period of patients admitted to the emergency department (ED) with a hyperglycemic crisis.
Materials and Method: This study was designed as retrospective, cross-sectional and observational. The patients who admitted to the ED with hyperglycemic crisis (diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome) and hospitalized were included in the study within 2 years between January 1, 2019, and January 1, 2021, in a level 3 education research hospital. The electronic patient database of the hospital was scanned for the determined period of the study with ICD codes [E10.1, E11.1, or E13.1 (diabetic ketoacidosis) or E11.0, E13.0, or E10.65 and E10.69 (hyperosmolar hyperglycemic syndrome)]. Patients under the age of 18 and patients whose disease histories could not be reached by blood tests were excluded from the study. Statistical significance was accepted as p<0.05.
Results: A total of 93 patients included in this study, which of 48 (51.6%) were female and 45 (48.4%) were male. The mean age of the patients was 63.49±26.59. The mean hospitalization period was determined as 6.25±5.16 days. In total, 7 patients (7.5%) were followed up in the intensive care unit (ICU), while mortality was observed in 2 (2.15%) of these patients. It was determined that there was a statistically significant association between hospitalization period of the patients and their findings such as age (r=0.879, p<0.001), Charlson index (r=0.708, p<0.001), PH value (r=0.312, 0.002), HCO3 value (r=0.316, p=0.002), BE value (r=-0.315, p=0.002).
Conclusion: It can be predicted that patients who admitted to the ED with DKA and HHS will have a long hospitalization due to blood gas analysis and comorbid diseases. Thus, the quality of treatment can be increased by measures such as education, early consultation of the diabetes team and early detection of triggering factors.

Keywords

Blood gas analysis, Diabetic ketoacidosis, Hyperosmolar hyperglycemic syndrome, Length of stay, Emergency department

References

• Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Diabetes Care 2018; 41: 2648-68.
• Endocrinologists AAoC. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 2009; 32.
• Kalkan S, Karatay E, Akbal E. Increased gastrointestinal symptom frequency in diabetes mellitus even with good glycemic control.J Health Sci Med 2020; 3: 26-30.
• Yiğenoğlu TN, KEBAPÇI MN, Hülya Ö. The significance of ankle-brachial index in determining peripheral artery disease in patients with type 2 diabetes mellitus over 40 years of age and the relationship of peripheral artery disease with chronic complications of diabetes. J Health Sci Med 2020; 3: 115-20.
• Handan A, YILMAZ S, Can FK, Parlak M. An evaluation of risk factors affecting amputation in patients with diabetic foot Infection. J Health Sci Med 2021; 4: 49-54.
• Draznin B, Gilden J, Golden S, Inzucchi S, Baldwin D, Bode B. for the PRIDE investigators. Pathways to quality inpatient management of hyperglycemia and diabetes: a call to action Diabetes Care 2013; 36: 1807-14.
• Kitabchi AE, Wall BM. Diabetic ketoacidosis. Med Clin North Am 1995; 79: 9-37.
• Gosmanov AR, Gosmanova EO, Dillard-Cannon E. Management of adult diabetic ketoacidosis. Diabetes Metab Syndr Obes 2014; 7: 255.
• Kim S. Burden of hospitalizations primarily due to uncontrolled diabetes: implications of inadequate primary health care in the United States. Diabetes care 2007; 30: 1281-2.
• Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes care 2009; 32: 1335-43.
• Patel M. Emergencies in diabetes–diabetic ketoacidosis and hyperosmolar hyperglycaemic state. Medicine 2020; 49: 106-9.
• Umpierrez G, Korytkowski M. Diabetic emergencies—ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol 2016; 12: 222.
• Benoit SR, Zhang Y, Geiss LS, Gregg EW, Albright A. Trends in diabetic ketoacidosis hospitalizations and in-hospital mortality—United States, 2000–2014. Morbidity and Mortality Weekly Report 2018; 67: 362.
• Zhong VW, Juhaeri J, Mayer-Davis EJ. Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998–2013: a retrospective cohort study. Diabetes Care 2018; 41: 1870-7.
• Poovazhagi V. Risk factors for mortality in children with diabetic keto acidosis from developing countries. World J Diabetes 2014; 5: 932.
• Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-83.
• Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.Am J Epidemiol 2011; 173: 676-82.
• Lange SJ, Ritchey MD, Goodman AB, Dias T, Twentyman E, Fuld J, et al. Potential indirect effects of the COVID‐19 pandemic on use of emergency departments for acute life‐threatening conditions—United States, January–May 2020. Wiley Online Library; 2020.
• Siregar NN, Soewondo P, Subekti I, Muhadi M. Seventy-two hour mortality prediction model in patients with diabetic ketoacidosis: a retrospective cohort study. J ASEAN Fed Endocr Soc 2018; 33: 124.
• Riddle MC, Bakris G, Blonde L, Boulton A. American Diabetes Association standards of medical care in diabetes–2019. Diabetes Care 2019; 42: 34-60.
• French EK, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. Bmj 2019; 365: I1114.
• Ibrahim A, Bayramoglu B, Hokenek NM, Tekyol D. Lactate clearance during the first 2 hours after hospital admission: A useful biomarker for predicting 30‐day mortality in patients with diabetic ketoacidosis. Int J Clin Pract 2021: e14204.
• Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011; 173: 676-82.
• Bansal V, Mottalib A, Pawar TK, et al. Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost. Bmj Open Diab Res Ca 2018; 6.
• Flanagan D, Moore E, Baker S, Wright D, Lynch P. Diabetes care in hospital—the impact of a dedicated inpatient care team. Diabet Med 2008; 25: 147-51.
• Sheahan KH, Atherly A, Dayman C, Schnure J. The impact of diabetology consultations on length of stay in hospitalized patients with diabetes.Endocrinol Diabetes Metab 2021; 4: e00199.