Factors associated with intensive care unit admission due to diabetic ketoacidosis in adults: a validated predictive model.

Abstract

Objective: The objective of this study was to develop a predictive model capable of determining the need for intensive care unit (ICU) admission of patients with diabetic ketoacidosis (DKA) during their assessment in the Emergency Department.

Methods: This is an observational study of consecutive cases including all adult patients diagnosed with DKA at a tertiary hospital between 2010 and 2024. Variables from medical history, physical examination, and laboratory tests at admission were collected and studied for their association with ICU admission. The sample was divided into two randomized parts: one to build a logistic regression model and another to validate it.

Results: Two hundred and thirty-one DKA events were included. Individuals had a mean age of 49.6 ± 19.9 years and 50.2% were male. Forty-eight point five percent of cases required ICU admission, and 30-day mortality was 4.8%. The best model to predict ICU admission included Glasgow Coma Scale (odds ratio [OR] = 0.64, p = 0.003), pH (OR = 0.0088, p = 0.005), bilirubin (OR = 0.13, p = 0.036), bicarbonate (OR = 0.0091, p = 0.013), and pH-bicarbonate interaction (OR = 3.78, p = 0.015). The model had an R² of 0.561, and the area under the curve (AUC) in the validation cohort was 0.842. Internal validation by bootstrap resampling showed an AUC = 0.871.

Conclusion: Variables associated with the severity of acidosis in patients with DKA predict the need for ICU admission better and earlier than other clinical variables.