Multiple organ failure and prognosis in adult patients with diabetic ketoacidosis

Objective: Evaluation of prognostic factors of patients presenting with dia betic ketoacidosis (DKA) at an emergency department. Design: Retrospective cohort study. Setting: The Emergency Department of the Vienna General Hospital, a 2000-be d tertiary care hospital. Patients and participants: Patients with DKA admitted from January 1, 1994 to September 30, 1998. Interventions: Treatment of DKA in accordance with a predefined regimen. Measurements and results: History, clinical findings, biochemical parameter s, blood gas analysis, multiorgan failure score (MOF) and treatment modalit ies were assessed. Patients were followed until death or hospital discharge . For group comparison the Mann Whitney U-test was used. Within the study period 21 patients were admitted because of diabetic ketoa cidosis (female:10, median age: 42 years; 31 to 58). All patients suffered from insulin-dependent diabetes mellitus and were treated according to a st andardised protocol. Six patients (29%) died in hospital. The non-survivors had significantly higher MOP-scores on admission (5 vs. 2, p < 0.001) and after 24 hours (4 vs. 0, p < 0.01) of intensive care treatment. Additionall y, non-survivors had significantly higher levels of GOT (64 vs. 8 U/I), GPT (28 vs. 11 U/I), BUN (34,63 vs. 12,14 mmol/l), creatinine ( 291,7 vs. 150, 3 mmol/l), amylase (315 vs. 78 U/I) and lipase (573 vs. 122 U/I) on admissi on than did survivors (p < 0.05), and also had a significantly higher net p ositive fluid balance after 24 hours (8.0 vs. 4.75 1, p < 0.05). All other parameters were not significantly different between the groups. Conclusion: Multiple organ failure may develop in patients with diabetic ke toacidosis and is associated with poor prognosis.