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

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.