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Volume 49, Number 5, October 2016

Clinical outcomes of septic patients with diabetic ketoacidosis between 2004 and 2013 in a tertiary hospital in Taiwan 


Yu-Chen Cheng, Chung-Hao Huang, Wei-Ru Lin, Po-Liang Lu, Ko Chang, Jih-Jin Tsai, Kebba S. Bojang, Chun-Yu Lin, Yen-Hsu Chen


 

Corresponding author:

Corresponding author. Chun-Yu Lin, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Number 100, Tzyou First Road, Kaohsiung City, Taiwan. 



 

Background and purpose: 

Infection is the most common predisposing factor for diabetic ketoacidosis (DKA); however, studies are rare that have investigated the clinical outcomes of septic patients with infection-precipitated DKA.

 



 

Methods:

A retrospective cohort study was conducted at a tertiary hospital from 2004 to 2013. Patients with DKA in whom the presence of a predisposing infection was confirmed were enrolled. Characteristics at initial presentation, primary infection sources, and causative microorganisms were compared between the nonacute kidney injury (non-AKI) group and acute kidney injury (AKI) group at each stage. Risk factors for the development of failure-stage AKI and its outcomes were also analyzed. 



 

Results:

One hundred and sixty DKA episodes were assessed. The most common infection sites were the urinary and respiratory tracts. The leading causative microorganism was Escherichia coli, followed by Klebsiella pneumoniae. A complicated/severe infection state [odds ratio (OR), 15.27; p < 0.001] and a high level of C-reactive protein (OR, 1.012; p < 0.001) were independently associated with bacteremia. Corrected sodium (Na; OR, 1.062; p = 0.039), initial plasma glucose (OR, 1.003; p = 0.041), severe grade of DKA (OR, 13.41; p = 0.045), and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.08; p = 0.033) were identified as independent risk factors for the development of failure-stage AKI among septic patients with infection-precipitated DKA. Patients with failure-stage AKI had a higher frequency of incomplete recovery of renal function (20.4% of patients in failure vs. 5.9% of patients in risk and injury, p = 0.009). Bacteremia independently predicted the absence of complete recovery of renal function (OR, 5.86; p = 0.038). 



 

Conclusion:

For patients with infection-precipitated DKA, the clinician should aggressively monitor renal function if a patient presents with risk factors associated with failure-stage AKI. Furthermore, bacteremia predicts a poor renal prognosis. 



 

Key words:

Acute kidney injury, Diabetic ketoacidosis, End-stage kidney disease (RIFLE) classification, Failure, Injury, Loss, Risk, Sepsis