Clinical characteristics and factors associated with mortality among adults with Diabetic Ketoacidosis presenting to emergency department of a tertiary hospital in Tanzania

Diabetic Ketoacidosis (DKA) is a severe acute complication of Diabetes Mellitus that often presents in the emergency department. It is associated with high mortality, particularly in low- and middle-income countries where mortality reaches 40%. However, there is a paucity of data on predictors of mortality in these settings to inform ways to reduce associated morbidity and mortality. We sought to determine predictors of mortality among adults with Diabetic Ketoacidosis presenting to the emergency department of a tertiary hospital in Tanzania. This was a retrospective cohort study of adult patients aged 18 years and above who presented with DKA to the emergency department of a tertiary hospital in Tanzania from 2017 to 2020. Data from electronic medical records were abstracted using a standardized form by trained abstractors. The primary outcome was overall mortality defined as death occurring either in the emergency department or after hospital admission during the index hospitalization. The association between predictors and mortality was determined using logistic regression analysis where a p-value of < 0.05 was considered statistically significant. Out of 173,565 adult patients seen at the emergency department during the study period, 238 met criteria for DKA, 18 (7.6%) were excluded due to missing outcome data, leaving 220 in the final analysis. The median age of the patients was 43.5 years IQR (31–56) and 118 (53.6%) were male. A total of 139 (63.2%) patients had type 2 diabetes, and 88 (40%) had additional comorbidities. The median pH was 7.16 IQR (7.1–7.3), median bicarbonate 9mmol/l IQR [5–13], and median potassium 4.30mmol/l IQR (3.5–5.1). Overall mortality was 36.8% (95% CI 32%-39%) including 21 (9.5%) deaths in the emergency department. Mechanical ventilation ( p < 0.001), and comorbidities ( p = 0.045) were independently associated with mortality. Diabetic Ketoacidosis is associated with high mortality in this resource-limited setting. Comorbidities and need for mechanical ventilation were associated with increased risk of death. Strengthening early risk identification, timely management and access to critical care may improve outcomes.