Acil serviste diyabetik ketoasidozda mortalite prediktörü olarak laktat düzeyleri

Yıl 2025, Cilt: 16 Sayı: 1, 20 - 26, 25.03.2025

Ömerul Faruk Aydın , Tahir Talat Yurttaş

https://doi.org/10.18663/tjcl.1581961

Öz

Amaç: Diyabetik ketoasidoz (DKA), özellikle acil servislerde diyabet hastalarında yaygın olarak görülen, hayatı tehdit eden metabolik bir bozukluktur. Yüksek riskli hastaların erken tespiti, mortalitenin azaltılması açısından kritik öneme sahiptir. Doku hipoksisinin bir belirteci olan laktat, DKA hastalarında sonuçları öngörmede prognostik değere sahip olabilir.
Gereç ve Yöntemler: Bu retrospektif çalışmaya, 1 Ocak 2019 - 1 Ocak 2024 tarihleri arasında üçüncü basamak bir sağlık merkezinin acil servisinde DKA tanısı alan hastalar dahil edilmiştir. Hastalar, hastanenin elektronik tıbbi kayıt sistemi kullanılarak belirlenmiştir. Toplanan veriler arasında demografik özellikler, klinik parametreler, laboratuvar sonuçları ve hasta sonuçları yer almıştır. DKA tanısı, hiperglisemi, metabolik asidoz ve ketonemi veya ketonüriyi içeren yerleşik klinik ve laboratuvar kriterlere dayanarak konulmuştur. Birincil sonuç ölçütü hastane içi mortalite olarak belirlenmiştir.
Bulgular: Çalışmaya toplam 85 hasta dahil edilmiştir ve hastaların ortalama yaşı 54 yıl (IQR: 35–70) olarak bulunmuştur. Çalışma popülasyonunun %44,7’si kadındı. Genel mortalite oranı %15,3 olup, 72 hasta (%84,7) sağ kalırken, 13 hasta (%15,3) hayatını kaybetmiştir. Hayatta kalamayan hastaların medyan yaşı, sağ kalanlara kıyasla anlamlı derecede daha yüksekti (66 yıl vs. 51 yıl, p = 0,049). Ayrıca, laktat seviyeleri hayatta kalamayan hastalarda sağ kalanlara kıyasla anlamlı derecede daha yüksekti ve bu durum, laktatın DKA hastalarındaki sonuçları öngörmede potansiyel bir prognostik role sahip olabileceğini göstermektedir.
Sonuç: Başvuru anındaki yüksek laktat seviyeleri, diyabetik ketoasidoz hastalarında artmış mortalite ile güçlü bir şekilde ilişkilidir. Acil serviste laktat seviyelerinin izlenmesi, yüksek riskli hastaların belirlenmesi ve erken müdahalelerin yönlendirilmesi için faydalı bir prognostik araç olabilir.

Anahtar Kelimeler

Diyabetik ketoasidoz, laktat, mortalite

Etik Beyan

This study was approved by the Taksim Education and Research Hosptial’s ethics committee (ethics committee ruling number: 13, date: 30.10.2024).

Destekleyen Kurum

YOK

Teşekkür

YOK

Lactate levels as a predictor of mortality in patients with diabetic ketoacidosis in the emergency department

Öz

Aim: Diabetic ketoacidosis (DKA) is a life-threatening metabolic disorder commonly seen in patients with diabetes, particularly in emergency departments. Early identification of high-risk patients is crucial for reducing mortality. Lactate, a marker of tissue hypoxia, may have prognostic value in predicting outcomes in DKA patients.
Material and Methods: This retrospective study included patients diagnosed with DKA in the emergency department of a tertiary healthcare center between January 1, 2019, and January 1, 2024. Patients were identified using the hospital's electronic medical records system. Data collected included demographic characteristics, clinical parameters, laboratory results, and patient outcomes. The diagnosis of DKA was based on established clinical and laboratory criteria, including hyperglycemia, metabolic acidosis, and ketonemia or ketonuria. The primary outcome was in-hospital mortality.
Results: A total of 85 patients were included in the study, with a mean age of 54 years (IQR: 35–70). Of the study population, 44.7% were female. The overall mortality rate was 15.3%, with 72 patients surviving (84.7%) and 13 patients not surviving (15.3%). The median age of non-survivors was significantly higher than that of survivors (66 years vs. 51 years, p = 0.049). Additionally, lactate levels were significantly higher in non-survivors than in survivors, indicating a potential prognostic role of lactate in predicting outcomes in DKA patients.
Conclusion: Elevated lactate levels at admission are strongly associated with increased mortality in patients with diabetic ketoacidosis. Monitoring lactate levels in the emergency department could be a useful prognostic tool for identifying high-risk patients and guiding early interventions.

Anahtar Kelimeler

Diabetic ketoacidosis, lactate, mortality

Etik Beyan

This study was approved by the Taksim Education and Research Hosptial’s ethics committee (ethics committee ruling number: 13, date: 30.10.2024).

Destekleyen Kurum

YOK

Teşekkür

YOK

Kaynakça

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