Can APACHE II Score Predict Diabetic Ketoacidosis in Hyperglycemic Patients Presenting to Emergency Department?

Abstract

Background: Diabetic ketoacidosis (DKA) is an acute and life-threatening complication in diabetic patients. The current diagnostic criteria of DKA are metabolic acidosis, blood glucose level greater than 250 mg/dL and the presence of ketones in serum or urine. DKA patients referring to the emergency department (ED) are usually ill. Objectives: The present study aims to evaluate the efficacy of Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring in predicting the critically illness in the hyperglycemic patients referring to the ED. Patients and Methods: We performed a prospective cohort study in an ED. One hundred eighty one patients older than 18 years with hyperglycemia were included in our study. Following the primary evaluation, the subjects were divided into DKA and non-DKA patients. APACHE II scores were calculated for all patients and then compared to each other. We determined predictive value, sensitivity, specificity and cut-off points of APACHE II score for DKA. Results: Sixty two patients had DKA. The comparison of APACHE II score among two groups of the patients did not show any significant difference (P = 0.597). There was no suitable cut-off point for APACHE II score to predict DKA. Conclusions: APACHE II score cannot be applied in the predicting of DKA in hyperglycemic patients admitted in ED. Keywords: Diabetic Ketoacidosis; APACHE II; Emergency Department