Clinical and biochemical predictors of intensive care unit admission among patients with diabetic ketoacidosis

Table 1 Comparison of demographics and baseline characteristics of diabetic ketoacidosis patients admitted to intensive care unit to those not admitted to intensive care unit, n (%)

Baseline characteristics	Admitted to ICU (n = 229)	Not admitted to ICU (n = 693)	P value
Age, mean ± SD, yr	40.4 ± 13.7	34.5 ± 14.6	< 0.001
Gender
Male	158 (69)	417 (60.2)
Female	71 (31)	276 (39.8)	0.020
Ethnicities
Arab	94 (41.1)	408 (58.9)	< 0.001
Asian	104 (45.4)	196 (28.2)
Africans	23 (10.1)	67 (9.7)
Others	8 (3.5)	22 (3.2)
BMI, median (IQR), kg/m2	24.6 (21.5-28.4)	23.7 (20.3-27.9)	0.030
DM diagnosis
T1DM	88 (38.43)	392 (56.6)	< 0.001
T2DM	141 (61.6)	301 (43.4)
HbA1c at admission (mean ± SD), < 6.5 %	12.1 ± 2.7	12.0 ± 2.8	0.600
Triggering factors
Non-compliance	45 (19.7)	217 (31.3)	0.001
Infection	77 (33.8)	164 (23.7)
New onset DM	61 (26.7)	162 (23.4)
Co-morbidities
Dyslipidaemia	36 (15.7)	92 (13.3)	0.300
Stroke	9 (3.9)	17 (2.45)	0.200
Coronary artery disease	17 (7.4)	39 (5.63)	0.300
Heart failure	6 (2.6)	6 (0.9)	0.040
Hypertension	56 (24.4)	143 (20.6)	0.200
DM retinopathy	17 (7.4)	61 (8.8)	0.500
DM nephropathy	10 (4.4)	50 (7.2)	0.100
COVID-19 infection at admission	9 (3.9)	2 (0.3)	< 0.001

ICU: Intensive care unit; BMI: Body mass index; T1DM: Type 1 diabetes mellitus; DM: Diabetes mellitus; COVID-19: Coronavirus disease 2019.

Table 2 Comparison of laboratory parameters of diabetic ketoacidosis patients admitted to intensive care unit to those not admitted to intensive care unit

Baseline characteristics	Units	Admitted to ICU (n = 229)	Not admitted to ICU (n = 693)	P value
Random blood glucose at admission, median (IQR)	mmol/L	24 (18.2-30.6)	23 (18.2-29.6)	0.290
White cell count at admission, median (IQR)	4-10 × 103/uL	15.1 (10.2-21.2)	11.2 (7.9-15.7)	< 0.001
Urea at admission, median (IQR)	mmol/L	6.5 (4.6-10.3)	5.6 (4.0-8.0)	< 0.001
Creatinine at admission, median (IQR)	umol/L	99 (75-144)	82 (63-114)	< 0.001
BHB at admission, median (IQR)	mmol/L	5.8 (4.6-7.1)	5.8 (4.5-7.4)	0.800
CRP at admission, median (IQR)	mg/L	27 (9-83)	14 (5-33)	< 0.001
Lactate at admission, median (IQR)	mmol/L	1.8 (1.2-3.1)	1.7 (1.1-2.7)	0.500
Serum pH at admission, mean ± SD	NA	7.10 ± 0.15	7.20 ± 0.13	< 0.001
Bicarbonate at admission, mean ± SD	mmol/L	9.2 ± 4.1	11.6 ± 4.3	< 0.001
Anion Gap at admission, median (IQR)	mEq/L	24.0 (19.2-29.0)	22 (17-27)	< 0.001
DKA severity	n (%)
Mild		24 (10.5)	178 (25.7)	< 0.001
Moderate		71 (31.0)	261 (37.7)
Severe		134 (58.5)	254 (36.6)

ICU: Intensive care unit; BHB: Beta-hydroxybutyrate; CRP: C-reactive protein; DKA: Diabetic ketoacidosis; NA: Not available.

Table 3 Comparison of outcomes of diabetic ketoacidosis patients admitted to intensive care unit to those not admitted to intensive care unit

Baseline characteristics	Units	Admitted to ICU (n = 229)	Not admitted to ICU (n = 693)	P value
Total length of stay, median (IQR)	d	4.2 (2.7-7.1)	2 (1-3.9)	< 0.001
DKA duration, median (IQR)	h	24 (13-37)	15 (19-24)	< 0.001
In-hospital mortality	n (%)	7 (3)	0	NA
Consult with diabetes educator	n (%)	115 (50.2)	233 (33.6)	< 0.001

ICU: Intensive care unit; NA: Not available.

Table 4 Logistic regression analysis factors predicting intensive care unit admission in diabetic ketoacidosis patients

Characteristics (n)	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value adjusted
Age (yr)	1.02 (1.01-1.03)	< 0.001	1.020 (1.006-1.040)	0.010
Male gender	1.47 (1.07-2.02)	0.010	0.86 (0.60-1.20)	0.400
DM diagnosis
T2D	2.08 (1.53-2.83)	< 0.001	1.2 (0.8-1.8)	0.400
Ethnicity
Arab	1	< 0.001	1.70 (1.17-2.56)	0.005
Asian	2.3 (1.7-3.2)
DKA trigger
Non-compliance	1		1
Infection	2.3 (1.5-3.4)	< 0.001	1.90 (1.22-3.06)	0.005
New DM	1.80 (1.17-2.80)	0.007	1.70 (1.06-2.76)	0.020
DKA severity
Mild	1		1
Moderate	2.01 (1.20-3.30)	0.006	2.60 (1.51-4.46)	0.001
Severe	3.90 (2.40-6.30)	< 0.001	4.70 (2.80-7.87)	< 0.001
NSTEMI during hospital stay	6.20 (1.54-25.00)	0.010	8.9 (1.2-66.9)	0.030
COVID-19 infection	14.13 (3-66)	0.001	7.8 (1.5-40.0)	0.010

DKA: Diabetic ketoacidosis; DM: Diabetes mellitus; T2DM: Type 2 diabetes mellitus; COVID-19: Coronavirus disease 2019; 95%CI: 95% confidence interval; OR: Odds ratio.