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Risk Factors for Adverse Outcomes in Children With Diabetic Ketoacidosis

Maha F Yousif1, Katie D Dolak1, Soumya Adhikari1

  • 1Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX 75390, USA.

The Journal of Clinical Endocrinology and Metabolism
|July 20, 2024
PubMed

Insights

A new model identifies children with diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) at risk for adverse outcomes. Type 2 diabetes and initial hyperglycemia/acidosis severity are key predictors, explaining increased risks during the COVID-19 pandemic.

Area of Science:

  • Pediatric Endocrinology
  • Critical Care Medicine
  • Diabetes Mellitus Research

Background:

  • Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are severe acute complications of diabetes in children.
  • Identifying children at high risk for adverse outcomes is crucial for timely intervention.
  • The COVID-19 pandemic may have impacted the incidence and severity of these conditions.

Purpose of the Study:

  • To develop and validate a multivariable predictive model for adverse outcomes in pediatric DKA/HHS.
  • To assess the impact of the COVID-19 pandemic on adverse outcomes in these patients.
  • To identify key risk factors associated with adverse outcomes in pediatric DKA/HHS.

Main Methods:

  • Retrospective review of 4565 pediatric admissions for DKA/HHS from 2010-2023 at a major children's hospital.
  • Data split into training (2010-2019) and validation (2020-2021, 2022-2023) sets.
  • Generalized estimating equations used to assess risks for a composite outcome of death or ICU stay >48 hours.

Main Results:

  • Adverse outcomes occurred in 1.5% (2010-2019), 5.0% (2020-2021), and 2.4% (2022-2023) of admissions.
  • Maximum serum glucose, initial pH, and type 2 diabetes diagnosis were strong predictors of adverse outcomes.
  • The predictive model demonstrated excellent discrimination (AUC 0.948-0.960) across datasets.

Conclusions:

  • Type 2 diabetes and severity of hyperglycemia/acidosis are independent risk factors for adverse outcomes in pediatric DKA/HHS.
  • These factors explain the increased frequency of adverse outcomes observed during the COVID-19 pandemic.
  • A significant decrease in adverse outcome risks was noted from January 2022 to June 2023.
Abstract

Keywords:
COVID-19diabetic ketoacidosisgeneralized estimating equationshyperglycemic hyperosmolar syndromelogistic regressionreceiver operator characteristic curve

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