Clinical Risk Scores to Predict Diabetic Ketoacidosis for Outpatient Type 2 Diabetic Patients in a Primary Care Context
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Abstract
Background and Objective: A diabetic ketoacidosis (DKA) diagnosis necessitated blood testing, which required the patient to wait for the results. Knowing the risk factors helped doctors screen patients to predict DKA effectively and accurately. The objective of this study was to create clinical risk scores to predict diabetic ketoacidosis in type 2 diabetic patients.
Design: Diagnostic Prediction Research
Methods: Retrospective data collection in type 2 diabetic patients with blood sugar levels greater than 250 mg % needed additional blood tests to confirm diabetic ketoacidosis during 2019-2022. Twenty-four patients had diabetic ketoacidosis and 48 patients tested negatively for diabetic ketoacidosis. Multivariable logistic regression assessed the predicting factors and created clinical risk scores.
Results: Four clinical predictive risk factors were scored: 1) blood sugar ≥ 400 mg%, 1 point. 2) poor compliance, 1.5 points, 3) Infection, 1.5 points, 4) abnormal symptoms of DKA, 2 points. The risk scores were classified into Group 1 low risk (≤ 4.5 points) and Group 2 high risk (> 4.5 points), These scores helped classify DKA using the area under the receiver operating characteristic curve of 88.06%. The low-risk group had PPV 41.50%, NPV 0% and the high-risk group had PPV 58.50%, NPV 100.00%.
Conclusions: This risk score might reliably predict diabetic ketoacidosis. Patients in the low-risk group were not investigated for diabetic ketoacidosis.
Keywords: risk score, diabetic ketoacidosis, type 2 diabetes mellitus, primary care
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