Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 35

35 - DOES APACHE SCORE PREDICT THE LENGTH OF HOSPITAL STAY IN DKA?

Saturday, Apr 27
10:30 AM – 11:00 AM

Objective : Diabetic Ketoacidosis is a commonly encountered clinical entity in the hospital. Many hospitals including our own utilize critical care areas to provide care for DKA patients. The Acute physiology and chronic health evaluation APACHE II is a severity of disease classification system used in critical care settings. A higher APACHE II score is associated with a higher severity of illness and mortality risk. We asked if APACHE score at admission for DKA patients was associated with length of stay in the ICU/hospital?


Methods : Data was retrospectively collected from EMR review for patients admitted to the medical ICU between January 1, 2017 and January 1, 2018. All patients with an admitting diagnosis of DKA were included. Data collected included medical history, laboratory tests and length of ICU/hospital stay. Patients who left against medical advice were excluded from the study. For patients with multiple DKA admissions, only the first admission was analyzed. 


Results : 55 hospitalizations met the inclusion criteria involving 50 patients. 5/55 patients had readmissions for DKA during the study period. The mean age of the patients was 47 yrs (range 17-85 yrs). 52%(n=26) of the population were males. The overall mean APACHE II at admission was 15 (range 3-28). We divided the study population in to 2 groups based on the APACHE scores: Low severity group (APACHE <=15)(n=25) and a high severity group (APACHE >15)(n=25). The mean APACHE scores were 9.9 and 18.7 for the low and high severity groups respectively. The average predicted mortality risk was 2.8% and 9.5% in the high and low severity groups respectively. There was no mortality in the study population. The average length of ICU/hospital stay was 1.6/3.65 and 1.54/3.61 days for the low and high severity groups respectively. 


Discussion : The hypothesized utility of APACHE scores in classifying severity of illness in DKA is the generation of prognostic information like mortality risk. It is well known that DKA has a 1-5% in hospital mortality. In the current study, the average predicted mortality risk was 2.8% and 9.5% in the low and high severity groups respectively. Our results suggest that as the APACHE scores increase, the predicted mortality is overestimated. A larger study is required to further elucidate this relationship. Moreover, the length of ICU/hospital stay does not correlate with the APACHE II score.


Conclusion : DKA is commonly managed in critical care settings in many hospitals. APACHE 2 provides limited prognostic information in DKA patients and tends to overestimate mortality risk. APACHE 2 scores should not be used to predict length of ICU/hospital stay in DKA patients.

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Puneet Dhillon

Resident
Abington Jefferson Health
Willow Grove, Pennsylvania

I'm a second year Internal Medicine Resident at Abington Jefferson Health. I have always been fascinated by Endocrinology.

Harshwant Grover

Resident
Abington Jefferson Health
Willow Grove, Pennsylvania

Second Year Internal Medicine Resident.

Jaspreet Virdi

Attending Physician
Abington Memorial Hospital
Abington, Pennsylvania

Attending Physician

Puneet Dhillon

Resident
Abington Jefferson Health
Willow Grove, Pennsylvania

I'm a second year Internal Medicine Resident at Abington Jefferson Health. I have always been fascinated by Endocrinology.