South Clin Ist Euras. 2024; 35(3): 288-292 | DOI: 10.14744/scie.2024.03880

The Predictive Power of Rapid Acute Physiology Score and Rapid Emergency Medicine Score in Mortality Risk of Diabetic Ketoacidosis Patients

Avni Uygar Seyhan¹, Rohat Ak¹, Yeþim Aylin Kalafat Demirdað¹, Ahmet Þahin¹, Yunus Emre Erdoðan², Burcu Aðýrbaþ³, Mukaddes Kübra Melemez⁴, Þevval Deke^5
1Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lütfi Kýrdar City Hospital, Ýstanbul, Türkiye
²Department of Emergency Medicine, Medicana Çamlýca Hospital, Ýstanbul, Türkiye
³Department of Emergency Medicine, Elbistan State Hospital, Kahramanmaraþ, Türkiye
⁴Department of Anesthesiology and Reanimation, University of Health Sciences, Haydarpaþa Numune Education and Research Hospital, Ýstanbul, Türkiye
⁵Department of Internal Medicine, University of Health Sciences, Sultan 2. Abdülhamid Han Education and Research Hospital, Ýstanbul, Türkiye

INTRODUCTION: This study aimed to evaluate the effectiveness of the Rapid Emergency Medicine Score (REMS) and the Rapid Acute Physiology Score (RAPS) in predicting mortality among patients with diabetic ketoacidosis (DKA) in the emergency department.
METHODS: A retrospective cross-sectional study was conducted on 111 patients diagnosed with DKA who were admitted to the emergency department of a tertiary hospital between June 1, 2021, and June 1, 2022. Inclusion criteria were patients aged 18 years and older who met the diagnostic criteria for DKA as defined by the American Diabetes Association. Data on vital signs, laboratory results, and clinical outcomes were collected. The predictive power of the REMS and RAPS scores for mortality was assessed using Receiver Operating Characteristic (ROC) curve analysis to determine the area under the curve (AUC) for each score. Descriptive statistics and non-parametric tests were used to analyze the data.
RESULTS: A total of 111 patients with DKA were included in this study. The cohort comprised 64 males (57.6%) and 47 females (42.3%), with a mean age of 51.86±20.27 years. Among the patients, 7 (6.31%) were discharged, 56 (50.45%) were admitted to the general ward, 35 (31.53%) to the intensive care unit (ICU), and 13 (11.71%) patients died. The REMS score demonstrated a higher predictive power for mortality in DKA patients, with an AUC of 0.712, compared to an AUC of 0.60 for the RAPS score.
DISCUSSION AND CONCLUSION: The REMS score proved to be a more effective tool than the RAPS score in predicting mortality among DKA patients. Given its higher accuracy and reliability, the REMS score could be valuable as an early warning system in the management of DKA in emergency settings. Routine use of REMS in similar critical conditions is recommended.

Keywords: Diabetic ketoaci-dosis, early warning systems; emergency department.

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Diyabetik Ketoasidoz Hastalarýnda Mortalite Riskinin Belirlenmesinde Hýzlý Akut Fizyoloji Skoru ve Hýzlý Acil Týp Skorunun Öngörü Gücü

Avni Uygar Seyhan¹, Rohat Ak¹, Yeþim Aylin Kalafat Demirdað¹, Ahmet Þahin¹, Yunus Emre Erdoðan², Burcu Aðýrbaþ³, Mukaddes Kübra Melemez⁴, Þevval Deke^5
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GÝRÝÞ ve AMAÇ: Bu çalýþma, acil serviste diyabetik ketoasidoz (DKA) hastalarýnda mortalite tahmininde Rapid Emergency Medicine Score (REMS) ve Rapid Acute Physiology Score (RAPS) skorlarýnýn etkinliðini deðerlendirmeyi amaçladý.
YÖNTEM ve GEREÇLER: Retrospektif kesitsel bir çalýþma, 1 Haziran 2021 - 1 Haziran 2022 tarihleri arasýnda bir üçüncü basamak hastanenin acil servisine baþvuran ve DKA tanýsý alan 111 hasta üzerinde gerçekleþtirildi. Dahil edilme kriterleri, Amerikan Diyabet Derneði tarafýndan tanýmlanan DKA taný kriterlerine sahip 18 yaþ ve üzeri hastalarý içeriyordu. Vital bulgular, laboratuvar sonuçlarý ve klinik sonuçlara iliþkin veriler toplandý. REMS ve RAPS skorlarýnýn mortaliteyi tahmin etme gücü, her bir skor için eðri altýndaki alaný (EAA) belirlemek amacýyla ROC (Receiver Operating Characteristic) eðrisi analizi kullanýlarak deðerlendirildi. Verilerin analizi için tanýmlayýcý istatistikler ve parametrik olmayan testler kullanýldý.
BULGULAR: Bu çalýþmaya toplam 111 DKA hastasý alýndý. Kohort, 64 erkek (%57.6) ve 47 kadýndan (%42.3) oluþmakta olup, yaþ ortalamasý 51.86±20.27 yýldýr. Hastalardan 7’si (%6.31) taburcu edilirken, 56’sý (%50.45) servise, 35’i (%31.53) yoðun bakým ünitesine (YBÜ) kabul edilmiþ ve 13 hasta (%11.71) hayatýný kaybetmiþtir. REMS skoru, DKA hastalarýnda mortaliteyi öngörmede RAPS skoruna kýyasla daha yüksek bir prediktif güce sahip olup, EAA deðeri 0.712 iken, RAPS skoru için bu deðer 0,60 olarak bulunmuþtur.
TARTIÞMA ve SONUÇ: REMS skoru, DKA hastalarýnda mortaliteyi tahmin etmede RAPS skorundan daha etkili bir araç olarak öne çýktý. Yüksek doðruluðu ve güvenilirliði göz önüne alýndýðýnda, REMS skoru, acil servislerde DKA yönetiminde erken uyarý sistemi olarak deðerli olabilir. REMS skorunun benzer kritik durumlarda rutin kullanýmýnýn deðerlendirilmesi önerilmektedir.

Anahtar Kelimeler: Acil servis, diyabetik ketoasidoz; erken uyarý sistemler.

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