Poor treatment outcome and associated factors among adult diabetic ketoacidosis patients admitted to Amhara regional referral hospitals at Emergency Departments, Northwest Amhara, Ethiopia, 2022; a retrospective cross-sectional study

Abstract

Abstract

Background: Diabetic ketoacidosis (DKA) is a significant public health problem associated with high morbidity, disability, and mortality worldwide. According to the International Diabetes Federation, the true prevalence of DKA is unknown but is estimated at around 24%. Most affected patients live in low- and middle-income countries. In Sub-Saharan Africa, particularly Ethiopia, mortality remains high among patients who are not promptly diagnosed and treated.

Objective: This study aimed to assess treatment outcomes and associated factors among adult DKA patients admitted to emergency departments at Comprehensive Specialized Hospitals in Northwest Amhara, Ethiopia, in 2022.

Methods: A multicenter, institution-based retrospective cross-sectional study was conducted from May 14, 2017, to May 15, 2022, including 495 participants selected via systematic random sampling. Binary logistic regression was used to identify factors associated with treatment outcomes. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated, and statistical significance was declared at p < 0.05.

Results: The proportion of poor treatment outcomes was 5.1% (95% CI: 3.3–7.6%). Factors significantly associated with poor outcomes included being uninsured (AOR = 3.23; 95% CI: 1.14–9.13), receiving less than 3 liters of fluid replacement (AOR = 3.86; 95% CI: 1.17–12.72), not receiving potassium replacement (AOR = 3.84; 95% CI: 1.44–10.22), and prolonged recovery time from DKA (>72 hours) (AOR = 3.93; 95% CI: 1.31–11.81).

Conclusion and Recommendation: The proportion of poor treatment outcomes was low compared to previous studies. Lack of health insurance, inadequate fluid or potassium replacement, and prolonged recovery time were associated with poor outcomes. Prompt fluid and potassium replacement and strategies to reduce recovery time, along with increasing community awareness about health insurance, are recommended to improve DKA management.

Keywords: Diabetic ketoacidosis, adult patients, treatment outcomes, associated factors, Amhara, Ethiopia