The relationship between initial lactate levels and outcomes in patients diagnosed with diabetic ketoacidosis in the emergency department

Abstract

Background/Aim: Diabetic ketoacidosis (DKA) is an endocrinological emergency frequently seen in emergency departments (ED). It can result in mortality if not treated appropriately. The aim of this study was to examine the relationship between baseline lactate levels and patient outcomes in DKA patients admitted to the emergency department (ED). Methods: This retrospective cohort study was carried out in the ED of a tertiary hospital between May 2022 and November 2022 using the data of patients diagnosed with DKA. Patients with missing data, patients transferred from another hospital, patients with a diagnosis other than DKA, and patients who could not be followed up were excluded from the study. The primary outcome of the study was admission to the intensive care unit (ICU) and/or in-hospital mortality. The area under the curve (AUC) was calculated by receiver operating characteristic (ROC) regression analyses to predict critically ill patients with lactate levels. Results: The study was completed with 95 patients. The mean age of the patients was 53.1 years and n = 46 were female. Twenty (21.1%) of these patients were admitted to the intensive care unit and 22 (23.2%) died. The statistical analysis showed that lactate levels were statistically significant in predicting critically ill patients (P < 0.001). ROC analysis showed that a lactate level of 2.6 mmol/dL could predict critically ill patients. The area under the curve was 0.823 (95% confidence interval: 0.731-0.894, sensitivity: 71.4, Specificity: 69.8), the Youden index was 0.476, and the P-value was 0.001. Conclusion: According to the results of this study, there is a significant relationship between the initial lactate levels in DKA patients and patients who will require critical care. Therefore, lactate can be used as an appropriate follow-up tool in the management of DKA patients.