Clinical Characteristics Of Diabetes Ketoacidosis With Acute Pancreatitis

Objective:To explore the clinical characteristics of diabetes ketoacidosis with acute pancreatitis,identify the risk factors,and improve clinicians’ understanding,diagnosis and treatment of DKA with AP.Methods:The clinical data of 45 patients with DKA combined with AP(DKA-AP group)admitted to the emergency department,digestive department,endocrinology department and critical medicine department of Yangzhou University Affiliated Hospital from September 2013 to December 2022 were analyzed retrospectively;The patients with simple DKA(DKA group)with equal number in the same time period were selected as the control group.After that,the basic data of the two groups of patients were statistically analyzed,and the differences in clinical manifestations,past history,personal history,laboratory and imaging examinations,clinical scores,treatment measures,disease outcomes and other related factors were compared.Single factor and multiple factor logistic regression analysis was performed to analyze the independent risk factors of DKA combined with AP,draw the receiver operating characteristic(ROC)curve,and calculate the area and the curve(AUC)to evaluate the predictive performance of the index.Results:1.Single factor analysis showed that BMI,history of hyperlipidemia,abdominal pain,duration of abdominal pain,HCT%,RBC count,HB concentration,blood glucose,TC,TG,and AMY in DKA-AP group were higher than those in DKA group,with statistical difference between the two groups(P<0.05).2.Multivariate logistic regression analysis: take the univariate results with statistical significance as the independent variable,and DKA combined with AP as the dependent variable.The results showed that abdominal pain(P<0.001,OR=38.906),abdominal pain duration(P<0.001,OR=3.892),TC(P<0.001,OR=1.455),TG(P=0.008,OR=2.046)were independent risk factors of DKA combined with AP.3.The ROC curve was drawn by multivariate logistic regression analysis of continuous variables with statistical significance.The results showed that the AUC of the duration of abdominal pain was 0.871,the sensitivity was 77.8%,the specificity was 86.7%,and the Jordan index was 0.644;The AUC of TC was 0.751,the sensitivity was 71.1%,the specificity was 75.6%,and the Yoden index was 0.467;The AUC of TG is 0.884,the sensitivity is 88.4%,the specificity is 84.4%,and the Yoden index is 0.664;The AUC of the combined diagnosis of the above indicators was 0.993,the sensitivity was 93.3%,the specificity was 73.3%,and the Yoden index was 0.667.4.There was a statistical difference between the two groups in APACHE II score(P=0.035).5.The average daily rehydration volume,CRRT use,hospital stay and average hospital expenses of the two groups were statistically significant(P<0.05).Conclusions:1.This study considers that abdominal pain,duration of abdominal pain,cholesterol and triglyceride are independent risk factors of DKA complicated with AP,and monitors the above indicators in order to identify AP as early as possible and make timely diagnosis and treatment.2.The accuracy of combined prediction of abdominal pain,duration of abdominal pain,cholesterol and triglyceride for DKA combined with AP was better than that of single factor prediction.3.DKA combined with AP hypovolemia is more obvious,and the probability of continuous organ function deterioration is greater than that of simple DKA.4.DKA combined with AP has longer hospitalization time and higher cost.