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BMI, BUN may predict death from diabetic ketoacidosis in children

Issue: May 2012

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Higher BMI and blood urea nitrogen levels are associated with an increased risk for death from diabetic ketoacidosis among children, according to data from a retrospective study.

Researchers from Advocate Lutheran General Children’s Hospital in Park Ridge, Ill., led by Suresh Havalad, MD, associate professor of pediatrics at Chicago Medical School and division director of Pediatric Critical Care at Advocate, analyzed data for all children aged younger than 19 years who presented to the hospital with diabetic ketoacidosis who survived (controls, n=122) and died (cases, n=10) during a 6-year period. They analyzed medical charts and autopsy reports and collected data on sample and treatment characteristics, serum chemistries, and histological or radiographic evidence for cerebral edema. Case-control comparisons were conducted using multivariate logistic-regression models and selected clinical parameters, including serum glucose, creatinine, blood urea nitrogen (BUN), calculated osmolality and BMI.

Death from diabetic ketoacidosis was significantly associated with BMI (OR=1.18; 95% CI, 1.07-1.31), BUN (OR=1.11; 95% CI, 1.04-1.18), glucose (OR=1; 95% CI, 1-1.01), creatinine (OR=3.94; 95% CI, 1.51-10.33) and calculated osmolality (OR=1.06; 95% CI, 1.03-1.08) in univariate analysis. In multivariate model, however, significant predictors of mortality were only BMI (OR=1.14; 95% CI, 1.03-1.27) and BUN (OR=1.09; 95% CI, 1.01-1.18).

Using established criteria for obesity and azotemia, children with diabetic ketoacidosis were more likely to die if BMI was .30 (OR=30.83; 95% CI, 5.35-177.36) and BUN was .40 mg/dL (OR=98.4; 95% CI, 9.23-1049.17), Havalad told Endocrine Today.

“Despite our small sample size, our results suggest that children with higher BMI and BUN are at increased risk of death from [diabetic ketoacidosis]. Further study is needed to confirm and extend these findings,” the researchers wrote in their abstract.