Materiały źródłowe

• #1 Early prediction models for prognosis of diabetic ketoacidosis in the emergency department

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8154382/

  Diabetic ketoacidosis (DKA) is one of the most serious complications after diabetes poor control, which seriously threatens human life, health, and safety. DKA can rapidly develop within hours or days leading to death. Early evaluation of the prognosis of DKA patients and timely and effective intervention are very important to improve the prognosis of patients. The combination of several variables or characteristics is used to predict the poor prognosis of DKA, which can allocate resources reasonably, which is beneficial to the early classification intervention and clinical treatment of the patients. […] This systematic review and meta-analysis will provide clinical basis for predicting the prognosis of DKA. It helps us to understand the value of predictive models in evaluating the early prognosis of DKA. The conclusions drawn from this study may be beneficial to patients, clinicians, and health-related policy makers.

• #2

  https://journals.lww.com/md-journal/fulltext/2021/05280/early_prediction_models_for_prognosis_of_diabetic.64.aspx

  Diabetic ketoacidosis (DKA) is one of the most serious complications after diabetes poor control, which seriously threatens human life, health, and safety. DKA can rapidly develop within hours or days leading to death. Early evaluation of the prognosis of DKA patients and timely and effective intervention are very important to improve the prognosis of patients. […] This systematic review and meta-analysis will provide clinical basis for predicting the prognosis of DKA. It helps us to understand the value of predictive models in evaluating the early prognosis of DKA. […] Early evaluation of DKA prognosis is important. A variable or feature used to assess the severity of DKA can help medical workers allocate medical resources reasonably and intervene early in the treatment of DKA. […] However, there is no systematic review or meta-analysis to the prognostic prediction model of DKA. […] Therefore, we carried out this systematic review to help clinicians to reasonably allocate medical resources by predicting different prognosis of DKA and to provide clinical evidence for timely and effective treatment.

• #3 Diabetes-Related Ketoacidosis (DKA): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka

  With prompt treatment, most people recover from diabetes-related ketoacidosis within a day. Sometimes, it takes longer. […] If you don’t get prompt treatment, DKA can lead to severe complications, including: very low potassium levels (hypokalemia), brain swelling (cerebral edema), fluid inside of your lungs (pulmonary edema), cardiac arrest, damage to your kidneys and other organs, coma, and death. […] Studies show that the survival rate of DKA continues to improve. With appropriate treatment, the survival rate is over 95%. But certain factors can affect mortality (death) rates. The following factors tend to lead to worse outcomes: getting treatment after you already have a coma, hypothermia and oliguria (low urine output), being over age 65 with coexisting acute conditions, like heart attack, pneumonia or sepsis, and having brain swelling (especially in younger people).

• #4 Euglycemic Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554570/

  Most patients with EDKA recover well with prompt recognition and treatment. Delayed diagnosis and inadequate treatment, especially hydration without dextrose/insulin infusion, can lead to persistent acidosis, vomiting, and prolonged hospitalization. The prognosis is worse for small children and pregnant women. Rarely, severe cases of respiratory failure, hypovolemic shock, coma, and death. Death is rare in most EDKA cases; however, pregnant women are at greater mortality risk than the general population. […] Euglycemic DKA can result in persistent vomiting, dehydration, hypoglycemia, hypovolemic shock, respiratory failure, cerebral edema, coma, seizures, infection, thrombosis, myocardial infarction, and death. Maternal EDKA can increase the rate of fetal (up to 9%) and maternal mortality.

• #5 Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review | The BMJ

  https://www.bmj.com/content/343/bmj.d4092

  Younger age was consistently associated with an increased risk of diabetic ketoacidosis at diagnosis. This increased risk was most noticeable in children less than 2 years old and was still present at 5 years, but by age 10 there was no significant difference. […] Children from ethnic minority groups seem to have an increased risk of developing diabetic ketoacidosis, but it is difficult to draw strong conclusions as the studies compared different ethnic groups, and we do not know the independent effect of ethnicity (rather than sociodemographic differences). […] Several physician level factors were also associated with an increased risk of diabetic ketoacidosis. Children who were not diagnosed at their first visit to a doctor had a threefold increased risk of presenting in diabetic ketoacidosis, and delays in starting treatment were associated with a small increased risk.

• #6 Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review | The BMJ

  https://www.bmj.com/content/343/bmj.d4092

  This study has implications for clinicians in both primary and secondary care, as the vast majority of children who develop type 1 diabetes will have a consultation before diagnosis. […] We found clear evidence that at least some children with diabetic ketoacidosis experienced diagnostic or treatment delays.

• #7 Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review | The BMJ

  https://www.bmj.com/content/343/bmj.d4092

  A history of prior infection was the only disease related factor associated with an increased risk of diabetic ketoacidosis. Infection is known to cause inflammation, pro-inflammatory cytokine release, and a counter regulatory response that collectively lead to insulin resistance and metabolic decompensation. […] Having a first degree relative with diabetes was associated with an up to sixfold decreased risk of diabetic ketoacidosis at diagnosis. […] The absence of any significant difference between children in whom a member of the family was subsequently diagnosed with diabetes and those without such a family history at the end of the follow-up period suggests that the protective effect of a first degree relative with diabetes at diagnosis was probably due to increased awareness among families with experience of diabetes rather than an increased genetic risk for type 1 diabetes predisposing to a milder onset of disease.

• #8 Early prediction models for prognosis of diabetic ketoacidosis in the emergency department

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8154382/

  Early evaluation of DKA prognosis is important. A variable or feature used to assess the severity of DKA can help medical workers allocate medical resources reasonably and intervene early in the treatment of DKA. But the combination of several variables or characteristics has a better evaluation of the prediction effect. […] Therefore, we carried out this systematic review to help clinicians to reasonably allocate medical resources by predicting different prognosis of DKA and to provide clinical evidence for timely and effective treatment.

• #9 Predictors and Predictive Score of In-Hospital Mortality in Diabetic Ketoacidosis: A Retrospective Cohort Study

  https://www.mdpi.com/1648-9144/60/11/1833

  Predictors and Predictive Score of In-Hospital Mortality in Diabetic Ketoacidosis: A Retrospective Cohort Study […] Background and Objectives: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus (DM). The primary objective of this study was to identify relevant clinical and biochemical predictors and create a predictive score for in-hospital DKA mortality. […] The primary outcome was in-hospital mortality. […] Significant predictors for in-hospital mortality of DKA included age > 55 years (OR 7.8, p = 0.007), female gender (OR 3.5, p < 0.001), anion gap > 30 mEq/L (OR 2.6, p = 0.003), hemoglobin levels < 10 g/dL (OR 16.9, p < 0.001), and the presence of cardiovascular disease (OR 1.3, p = 0.046). [...] The predictive performance of the scoring system was 0.82 based on the area under the curve, with a sensitivity of 73.8% and specificity of 96.4%. [...] Multiple clinical and biochemical factors, along with a predictive risk score, could assist in predicting in-hospital mortality of DKA and serve as a guide for physicians to identify patients at high risk. [...] The present study revealed a mortality rate of 10.7%. [...] This elevated mortality rate underscores the critical need for improvement in both pre-hospital and in-hospital care for DKA patients. [...] The proposed predictive score, which incorporated these five predictors and underwent internal validation, exhibited high predictive accuracy in predicting in-hospital mortality for patients with DKA. [...] Integrating these predictors and the predictive score into routine clinical practice may help physicians identify high-risk DKA patients, enabling them to implement targeted interventions and allocate resources more efficiently. [...] The present study developed a novel scoring system to predict in-hospital mortality for adult DKA patients, which represents the latest scoring system since the previous system was introduced in 2002. [...] Future external validation using a larger cohort and an exploration of how the predictive score could be integrated into various clinical workflows would enhance the practical impact of this predictive risk score.

• #10 Machine learning based prediction models for the prognosis of COVID-19 patients with DKA | Scientific Reports

  https://www.nature.com/articles/s41598-025-85357-9

  Patients with Diabetic ketoacidosis (DKA) have increased critical illness and mortality during coronavirus diseases 2019 (COVID-19). […] The LR model demonstrated the highest accuracy (AUC=0.933) in predicting mortality. Additionally, the LR model excelled (AUC=0.898) in predicting progression to severe disease. […] This study developed a machine learning-based predictive model for the progression to severe disease or death in COVID-19 patients with DKA, which can serve as a valuable tool to guide clinical treatment decisions. […] The coexistence of DKA and COVID-19 is linked to an increased mortality rate, influenced by the patients age and the severity of their COVID-19 infection. However, the precise impact of COVID-19 infection on the prognosis of DKA remains uncertain. […] The study found that machine learning models could serve as effective tools for predicting the progression to severe disease or mortality in COVID-19 patients with DKA.

• #11 Machine learning based prediction models for the prognosis of COVID-19 patients with DKA | Scientific Reports

  https://www.nature.com/articles/s41598-025-85357-9

  The LR model identified age as the most significant factor influencing outcomes. […] The LR model achieved the highest accuracy (0.875) and AUC (0.898) in predicting the progression of patients to severe illness. […] Therefore, the LR model was chosen as the most effective algorithm for predicting the progression to death or severe disease in COVID-19 patients with DKA. […] In conclusion, our study indicates that predictive models developed using machine learning algorithms based on clinical data can forecast the risk of progression to severe outcomes or mortality in COVID-19 patients with DKA.

• #12 Clinical nomogram prediction model to assess the risk of prolonged ICU length of stay in patients with diabetic ketoacidosis: a retrospective analysis based on the MIMIC-IV database | BMC Anesthesiology | Full Text

  https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-024-02467-z

  The duration of hospitalization, especially in the intensive care unit (ICU), for patients with diabetic ketoacidosis (DKA) is influenced by patient prognosis and treatment costs. […] Reducing ICU length of stay (LOS) in patients with DKA is crucial for optimising healthcare resources utilization. […] This study aimed to establish a nomogram prediction model to identify the risk factors influencing prolonged LOS in ICU-managed patients with DKA, which will serve as a basis for clinical treatment, healthcare safety, and quality management research. […] The nomogram prediction model proposed in this study has a high clinical application value for predicting prolonged ICU LOS in patients with DKA. […] This model can help clinicians identify patients with DKA at risk of prolonged ICU LOS, thereby enhancing prompt intervention and improving prognosis.

• #13 Clinical nomogram prediction model to assess the risk of prolonged ICU length of stay in patients with diabetic ketoacidosis: a retrospective analysis based on the MIMIC-IV database | BMC Anesthesiology | Full Text

  https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-024-02467-z

  The length of hospitalisation in patients with DKA may be influenced by their prognosis. […] Therefore, the LOS of patients with DKA, especially in the ICU, is closely related to patient prognosis and treatment cost. […] Previous studies have shown that several factors influence LOS in patients with DKA. […] Therefore, this study aimed to develop a nomogram prediction model to identify the risk factors influencing prolonged ICU LOS in patients with DKA. […] The results revealed OASIS, GCS, AKI stage, vasoactive agents, and myocardial infarction as the risk factors for ICU LOS prolongation in patients with DKA. […] The nomogram predicting the individual probability of prolonged ICU LOS in patients with DKA was constructed using the predictor variables. […] The AUC of our nomogram was determined to be 0.870 and 0.858 in the training and validation cohorts, respectively, indicating a satisfactory predictive performance.

• #14 Clinical nomogram prediction model to assess the risk of prolonged ICU length of stay in patients with diabetic ketoacidosis: a retrospective analysis based on the MIMIC-IV database | BMC Anesthesiology | Full Text

  https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-024-02467-z

  The nomogram developed in this study predicts the possibility of prolonged ICU LOS in patients with DKA based on medical history information, clinical investigations, and medications. […] The five indicators included in our nomogram are relatively simple, easily accessible for critical care physicians and nurses, and can assist clinicians in making timely decisions and targeted interventions.

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