糖尿病酮症酸中毒合并急性胰腺炎住院患者的临床结果：一项全国性分析

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.090

Michael Fatuyi MD, Mohammad Amin Eshghabadi MD, Gregory Pierce BS, Brenda Pierce MD, Natalie Assaf BA, M Kenan Rahima MD, ReyhanehSadat Rahima MD, Borna Mansouri MD, Sila Mateo Faxas MD, Jason Pichardo MD, Fayaz Khan MD, Mohammed Najdat Seijari MD, Muayad Alzamara MD, Shahla Mallick MD, Mian Hammas MD

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引用次数: 0

摘要

背景/简介尽管具有临床相关性，但目前缺乏评估糖尿病酮症酸中毒（DKA）和急性胰腺炎（AP）住院患者临床结局的综合研究。其次，本研究旨在评估这一特定患者群体的临床结果。方法对2017-2021年住院的成人糖尿病酮症酸中毒（DKA）和急性胰腺炎（AP）患者进行查询。主要终点是住院病人死亡率。次要结局包括心脏骤停、胃肠道出血（GIB）、插管、住院时间（LOS）和总住院费用。采用多变量logistic回归分析估计临床结果。假定值& lt;0.05被认为是显著的。结果我们分析了1,593,213例糖尿病酮症酸中毒（DKA）住院患者，其中75,769例（4.8%）并发急性胰腺炎（AP）。有DKA和AP的队列与没有AP的DKA队列的平均年龄分别为44.7岁和46.4岁；男性患病率39.7% vs 49.1%；白人占50.2%，白人占54.8%。临床结果显示住院死亡率3.8%对3.7% (OR 1.22, CI 1.12 - 1.33)；心脏骤停发生率1.8%对1.7% (OR 1.15, CI 1.01 - 1.30)；插管需求为9.7%对6.4% (OR 1.69, CI 1.60 - 1.79)；胃肠道出血率5.7%对3.9% (OR 1.54, CI 1.44 - 1.66)；住院时间（LOS） 6.7天vs 5.1天（IRR 1.36, CI 1.34 - 1.40）；医院总收费为20,727.41美元对14,586.77美元（内部比值1.44，可信区间1.40 - 1.48）。p值均小于0.05。结论本研究强调了糖尿病酮症酸中毒（DKA）和急性胰腺炎（AP）住院患者的临床结局与单独DKA患者的临床结局有显著差异。并发DKA和AP的患者表现出更高的死亡率、心脏骤停、插管、胃肠道出血、更长的住院时间和更高的医院费用。这些发现强调需要提高临床意识和积极主动的管理策略，以减轻DKA和AP患者的不良后果。需要进一步的研究来探索潜在的机制，并制定有针对性的干预措施来改善这一高危人群的预后。

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Clinical outcomes in patients hospitalized with diabetic ketoacidosis and acute pancreatitis: A nationwide analysis

Background/Synopsis

Despite the clinical relevance, there is a scarcity of comprehensive studies evaluating the clinical outcomes of patients hospitalized with both diabetic ketoacidosis (DKA) and acute pancreatitis (AP).

Objective/Purpose

Consequently, this study aims to assess the clinical outcomes in this specific patient population.

Methods

We queried the National Inpatient Sample from 2017-2021 for adult patients hospitalized with diabetic ketoacidosis (DKA) and acute pancreatitis (AP). The primary outcome was inpatient mortality. Secondary outcomes included cardiac arrest, gastrointestinal bleeding (GIB), intubation, length of stay (LOS), and total hospital charge. A multivariable logistic regression analysis was used to estimate clinical outcomes. P-value < 0.05 was considered significant.

Results

We analyzed 1,593,213 hospitalizations with diabetic ketoacidosis (DKA) and identified 75,769 cases (4.8%) with concurrent acute pancreatitis (AP). The cohorts with DKA and AP versus DKA without AP had a mean age of 44.7 vs. 46.4 years; male prevalence of 39.7% vs. 49.1%; and White ethnicity distribution of 50.2% vs. 54.8%. Clinical outcomes indicated a hospitalization mortality rate of 3.8% vs. 3.7% (OR 1.22, CI 1.12 - 1.33); a cardiac arrest incidence of 1.8% vs. 1.7% (OR 1.15, CI 1.01 - 1.30); an intubation requirement of 9.7% vs. 6.4% (OR 1.69, CI 1.60 - 1.79); a gastrointestinal bleeding rate of 5.7% vs. 3.9% (OR 1.54, CI 1.44 - 1.66); a length of stay (LOS) of 6.7 days vs. 5.1 days (IRR 1.36, CI 1.34 - 1.40); and total hospital charges of $20,727.41 vs. $14,586.77 (IRR 1.44, CI 1.40 - 1.48). All p-values were less than 0.05.

Conclusions

This study highlights the significant differences in clinical outcomes between patients hospitalized with diabetic ketoacidosis (DKA) and acute pancreatitis (AP) compared to those with DKA alone. Patients with concurrent DKA and AP exhibited higher rates of mortality, cardiac arrest, intubation, gastrointestinal bleeding, longer hospital stays, and increased hospital charges. These findings underscore the need for heightened clinical awareness and proactive management strategies for patients with both DKA and AP to mitigate these adverse outcomes. Further research is warranted to explore the underlying mechanisms and develop targeted interventions to improve prognosis in this high-risk population.

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.