- 學位論文
Epidemiological study of Infection-Precipitated Diabetic Ketoacidosis (DKA)
Epidemiological study of Infection-Precipitated Diabetic Ketoacidosis (DKA)
摘要
Abstract Introduction Diabetic ketoacidosis is the most common acute life-threatening complication in patients with diabetes mellitus and can lead to death without treatment. Its basic underlying mechanism is the reduction in net effective action of circulating insulin as a result of decreased insulin secretion or ineffective action of insulin coupled with elevation in levels of counterregulatory hormones. The commonest precipitating factors in its development are infection and inadequate or inappropriate treatment. Aim The aim of this study was to carry out an epidemiological survey on infection-precipitated DKA. Methods and patients Medical records of all the DKA cases at Kaohsiung Medical University Hospital (KMUH) from January 2003 to April 2009 were reviewed retrospectively. The main causes of each DKA episode were divided into infection, noncompliance with treatment, newly-diagnosed, pancreatitis and others. For the infection-precipitated cases, clinical characteristics including specific infections, specific pathogens and infection foci were analyzed. Results 360 cases of DKA were included in this study majority (52.5%) of which were precipitated by infection. Of the infection-precipitated DKA cases, Klebsiella pneumoniae (29.3%) and Escherichia coli (21.2%) were the leading causative pathogens. Klebsiella pneumoniae was also found to be the main cause of bacteremia in these patients. Urinary tract (28.5%) and respiratory tract (26.1%) were the commonest infection foci. Cases with type 2 DM, in comparison of their clinical characteristics to those with type 1 DM, were older and had higher BMI (23.1 ± 4.7 vs. 20.1 ± 4.3, P = 0.006). They also had a longer hospital admission, higher CRP level and lower HDL level. Comparison of bacteremia and non-bacteremia showed higher CRP levels in bacteremic group. Conclusions In infection-precipitated DKA patients, Klebsiella Pneumoniae is the most common cause of infection in Taiwan. Urinary tract is the commonest focus of infection and patients with type 2 DM have a more severe disease condition than those of type 1 DM.
並列摘要
Abstract Introduction Diabetic ketoacidosis is the most common acute life-threatening complication in patients with diabetes mellitus and can lead to death without treatment. Its basic underlying mechanism is the reduction in net effective action of circulating insulin as a result of decreased insulin secretion or ineffective action of insulin coupled with elevation in levels of counterregulatory hormones. The commonest precipitating factors in its development are infection and inadequate or inappropriate treatment. Aim The aim of this study was to carry out an epidemiological survey on infection-precipitated DKA. Methods and patients Medical records of all the DKA cases at Kaohsiung Medical University Hospital (KMUH) from January 2003 to April 2009 were reviewed retrospectively. The main causes of each DKA episode were divided into infection, noncompliance with treatment, newly-diagnosed, pancreatitis and others. For the infection-precipitated cases, clinical characteristics including specific infections, specific pathogens and infection foci were analyzed. Results 360 cases of DKA were included in this study majority (52.5%) of which were precipitated by infection. Of the infection-precipitated DKA cases, Klebsiella pneumoniae (29.3%) and Escherichia coli (21.2%) were the leading causative pathogens. Klebsiella pneumoniae was also found to be the main cause of bacteremia in these patients. Urinary tract (28.5%) and respiratory tract (26.1%) were the commonest infection foci. Cases with type 2 DM, in comparison of their clinical characteristics to those with type 1 DM, were older and had higher BMI (23.1 ± 4.7 vs. 20.1 ± 4.3, P = 0.006). They also had a longer hospital admission, higher CRP level and lower HDL level. Comparison of bacteremia and non-bacteremia showed higher CRP levels in bacteremic group. Conclusions In infection-precipitated DKA patients, Klebsiella Pneumoniae is the most common cause of infection in Taiwan. Urinary tract is the commonest focus of infection and patients with type 2 DM have a more severe disease condition than those of type 1 DM.