Analysis of the variables involved in the time to resolution of metabolic parameters in adults with diabetic ketoacidosis

Introduction. Diabetic ketoacidosis (DKA) is a life-threatening complication characterized by hyperglycemia, metabolic acidosis, and ketonemia. Although the time to resolution of DKA has been estimated at 12 to 18 hours, the factors that could prolong it have not been fully studied. Methods. Retrosp...

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Autores principales: Ramírez Stieben, Luis Agustín, Gago Noble, Paula María, Jaimet, María Celia
Formato: Artículo revista
Lenguaje:Español
Publicado: Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022
Materias:
diabetes mellitus
diabetic ketoacidosis
hyperglycemia
cetoacidosis diabética
hiperglucemia
cetoacidose diabética
hiperglicemia
Acceso en línea:https://revistas.unc.edu.ar/index.php/med/article/view/34968
Aporte de:
Revista de la Facultad de Ciencias Médicas de Córdoba de Universidad Nacional de Córdoba
id I10-R327-article-34968
record_format ojs
institution Universidad Nacional de Córdoba
institution_str I-10
repository_str R-327
container_title_str Revista de la Facultad de Ciencias Médicas de Córdoba
language Español
format Artículo revista
topic diabetes mellitus
diabetic ketoacidosis
hyperglycemia
diabetes mellitus
cetoacidosis diabética
hiperglucemia
diabetes mellitus
cetoacidose diabética
hiperglicemia
spellingShingle diabetes mellitus
diabetic ketoacidosis
hyperglycemia
diabetes mellitus
cetoacidosis diabética
hiperglucemia
diabetes mellitus
cetoacidose diabética
hiperglicemia
Ramírez Stieben, Luis Agustín
Gago Noble, Paula María
Jaimet, María Celia
Analysis of the variables involved in the time to resolution of metabolic parameters in adults with diabetic ketoacidosis
topic_facet diabetes mellitus
diabetic ketoacidosis
hyperglycemia
diabetes mellitus
cetoacidosis diabética
hiperglucemia
diabetes mellitus
cetoacidose diabética
hiperglicemia
author Ramírez Stieben, Luis Agustín
Gago Noble, Paula María
Jaimet, María Celia
author_facet Ramírez Stieben, Luis Agustín
Gago Noble, Paula María
Jaimet, María Celia
author_sort Ramírez Stieben, Luis Agustín
title Analysis of the variables involved in the time to resolution of metabolic parameters in adults with diabetic ketoacidosis
title_short Analysis of the variables involved in the time to resolution of metabolic parameters in adults with diabetic ketoacidosis
title_full Analysis of the variables involved in the time to resolution of metabolic parameters in adults with diabetic ketoacidosis
title_fullStr Analysis of the variables involved in the time to resolution of metabolic parameters in adults with diabetic ketoacidosis
title_full_unstemmed Analysis of the variables involved in the time to resolution of metabolic parameters in adults with diabetic ketoacidosis
title_sort analysis of the variables involved in the time to resolution of metabolic parameters in adults with diabetic ketoacidosis
description Introduction. Diabetic ketoacidosis (DKA) is a life-threatening complication characterized by hyperglycemia, metabolic acidosis, and ketonemia. Although the time to resolution of DKA has been estimated at 12 to 18 hours, the factors that could prolong it have not been fully studied. Methods. Retrospective study of medical records of adult patients admitted to the general ward with a diagnosis of DKA. They were classified according to severity as mild, moderate and severe. The time to resolution of crisis (TRC) was defined as that necessary until normalization of metabolic parameters. A logistic regression analysis was performed to evaluate the association between TRC>12 hours and continuous variables. ROC analysis and survival analysis were performed using a Cox regression model. Results. 85 patients were studied. 48.23% presented severe DKA. The TRC was 14 hours, being higher in severe DKA. Patients with TRC>12 hours had a lower pH and HCO3-, and a higher anion gap, white blood cells, and volume of crystalloids used. Logistic regression analysis showed that pH and crystalloid volume correlated with TRC>12 hours. ROC analysis determined a pH cutoff value of 7.13 for TRC>12 hours (sensitivity 77%, specificity 88%). The Cox regression showed that a pH<7.13 on admission is associated with a higher TRC (HR 3.30). Conclusion. A pH lower than 7.13 at the time of hospital admission identifies patients with DKA who will need a longer time to resolve their metabolic parameters.
publisher Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
publishDate 2022
url https://revistas.unc.edu.ar/index.php/med/article/view/34968
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AT ramirezstiebenluisagustin analisisdelasvariablesinvolucradaseneltiempoderesoluciondelosparametrosmetabolicosenadultosconcetoacidosisdiabetica
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spelling I10-R327-article-349682022-09-29T15:08:29Z Analysis of the variables involved in the time to resolution of metabolic parameters in adults with diabetic ketoacidosis Análisis de las variables involucradas en el tiempo de resolución de los parámetros metabólicos en adultos con cetoacidosis diabética Análise das variáveis ​​envolvidas no tempo de resolução dos parâmetros metabólicos em adultos com cetoacidose diabética Ramírez Stieben, Luis Agustín Gago Noble, Paula María Jaimet, María Celia diabetes mellitus diabetic ketoacidosis hyperglycemia diabetes mellitus cetoacidosis diabética hiperglucemia diabetes mellitus cetoacidose diabética hiperglicemia Introduction. Diabetic ketoacidosis (DKA) is a life-threatening complication characterized by hyperglycemia, metabolic acidosis, and ketonemia. Although the time to resolution of DKA has been estimated at 12 to 18 hours, the factors that could prolong it have not been fully studied. Methods. Retrospective study of medical records of adult patients admitted to the general ward with a diagnosis of DKA. They were classified according to severity as mild, moderate and severe. The time to resolution of crisis (TRC) was defined as that necessary until normalization of metabolic parameters. A logistic regression analysis was performed to evaluate the association between TRC>12 hours and continuous variables. ROC analysis and survival analysis were performed using a Cox regression model. Results. 85 patients were studied. 48.23% presented severe DKA. The TRC was 14 hours, being higher in severe DKA. Patients with TRC>12 hours had a lower pH and HCO3-, and a higher anion gap, white blood cells, and volume of crystalloids used. Logistic regression analysis showed that pH and crystalloid volume correlated with TRC>12 hours. ROC analysis determined a pH cutoff value of 7.13 for TRC>12 hours (sensitivity 77%, specificity 88%). The Cox regression showed that a pH<7.13 on admission is associated with a higher TRC (HR 3.30). Conclusion. A pH lower than 7.13 at the time of hospital admission identifies patients with DKA who will need a longer time to resolve their metabolic parameters. Introducción. La cetoacidosis diabética (CAD) es una complicación potencialmente mortal caracterizada por hiperglucemia, acidosis metabólica y cetonemia. Aunque el tiempo para la resolución de la CAD se ha estimado en 12 a 18 horas, los factores que podrían prolongarlo no se han estudiado con exhaustividad. Métodos. Estudio retrospectivo de historias clínicas de pacientes adultos admitidos a sala general con diagnóstico de CAD. Se clasificaron según la severidad en leve, moderada y severa. El tiempo de resolución de la crisis (TRC) se definió como aquel necesario hasta normalización de parámetros metabólicos. Se realizó un análisis de regresión logística para evaluar la asociación entre TRC>12 horas y variables continuas. Se realizó un análisis ROC y un análisis de supervivencia utilizando un modelo de regresión de Cox. Resultados. Se estudiaron 85 pacientes. El 48.23% presentó CAD severa. El TRC fue de 14 horas, siendo mayor en CAD severa. Los pacientes con TRC>12 horas presentaron menor pH y HCO3, y mayor anión gap, glóbulos blancos y volumen de cristaloides utilizados. El análisis de regresión logística demostró que el pH y el volumen de cristaloides correlacionaron con TRC>12 horas. El análisis ROC determinó un valor de corte de pH de 7.13 para TRC>12 horas (sensibilidad 77%, especificidad 88%). La regresión de Cox demostró que un pH <7.13 al ingreso se asocia a mayor TRC (HR 3.30). Conclusión. Un pH menor a 7.13 al momento de admisión hospitalaria identifica a pacientes con CAD que necesitarán un mayor tiempo para resolver sus parámetros metabólicos. Introdução. A cetoacidose diabética (CAD) é uma complicação com risco de vida caracterizada por hiperglicemia, acidose metabólica e cetonemia. Embora o tempo para resolução do CAD tenha sido estimado em 12 a 18 horas, os fatores que poderiam prolongá-lo não foram totalmente estudados. Métodos. Estudo retrospectivo de prontuários de pacientes adultos internados na enfermaria geral com diagnóstico de CAD. Eles foram classificados de acordo com a gravidade em leve, moderado e grave. O tempo de resolução da crise (TRC) foi definido como o necessário até a normalização dos parâmetros metabólicos. Foi realizada análise de regressão logística para avaliar a associação entre TRC>12 horas e variáveis ​​contínuas. A análise ROC e a análise de sobrevivência foram realizadas usando um modelo de regressão de Cox. Resultados. 85 pacientes foram estudados. 48.23% apresentavam DAC grave. O TRC foi de 14 horas, sendo maior na CAD grave. Pacientes com TRC>12 horas apresentaram pH e HCO3- mais baixos, e maior gap aniônico, leucócitos e volume de cristaloides usados. A análise de regressão logística mostrou que o pH e o volume de cristalóide se correlacionaram com TRC>12 horas. A análise ROC determinou um valor de corte de pH de 7.13 para TRC>12 horas (sensibilidade 77%, especificidade 88%). A regressão de Cox mostrou que um pH <7.13 na admissão está associado a um TRC maior (HR 3.30). Conclusão. Um pH menor que 7.13 no momento da admissão hospitalar identifica os pacientes com CAD que precisarão de mais tempo para resolver seus parâmetros metabólicos. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022-09-16 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Text Texto Texto application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/34968 10.31053/1853.0605.v79.n3.34968 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 79 No. 3 (2022); 223-227 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 79 Núm. 3 (2022); 223-227 Revista da Faculdade de Ciências Médicas de Córdoba; v. 79 n. 3 (2022); 223-227 1853-0605 0014-6722 10.31053/1853.0605.v79.n3 spa https://revistas.unc.edu.ar/index.php/med/article/view/34968/38810 https://revistas.unc.edu.ar/index.php/med/article/view/34968/38837 Derechos de autor 2022 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0

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