{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:59:55Z","timestamp":1790373595947,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet & Metabol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Aims<\/jats:title>\n Diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis is common in low\u2010resource settings and associated with prolonged hospitalisation. We aimed to identify determinants of time to discharge among children with new\u2010onset DKA in Zambia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a retrospective cohort study of children aged 0\u201316\u2009years with newly diagnosed T1DM and DKA at the University Teaching Hospital, Lusaka (2018\u20132023). The primary outcome was time to discharge (days). We used Kaplan\u2013Meier with log\u2010rank tests and Cox regression. To address proportional hazards (PH) violation, we fitted a stratified Cox model (stratified by HbA1c, vomiting and DKA severity) for PH validation and a granulated Cox model with DKA severity (mild, moderate, severe) to estimate independent effects. PH was verified using Schoenfeld residuals.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 353 children (mean age 8.3\u2009years, SD 4.6), median stay was 5\u2009days (IQR 4\u20138). Log\u2010rank tests showed significant differences in discharge probability by DKA severity (\u03c7\n 2<\/jats:sup>\n \u2009=\u200970.32,\n p<\/jats:italic>\n \u2009<\u20090.001) and vomiting (\u03c7\n 2<\/jats:sup>\n \u2009=\u200930.35,\n p<\/jats:italic>\n \u2009<\u20090.001). In the granulated model, DKA severity was the strongest predictor of delayed discharge (moderate: HR\u2009=\u20090.01,\n p<\/jats:italic>\n \u2009<\u20090.001; severe: HR\u2009=\u20090.01,\n p<\/jats:italic>\n \u2009<\u20090.001), while infection was associated with faster discharge (HR\u2009=\u20091.51,\n p<\/jats:italic>\n \u2009<\u20090.001). Ketonuria lost significance after DKA adjustment (HR\u2009=\u20090.90,\n p<\/jats:italic>\n \u2009=\u20090.770), indicating a marker not an independent predictor. The stratified model confirmed PH satisfaction (global test \u03c7\n 2<\/jats:sup>\n \u2009=\u20095.62, df\u2009=\u20097,\n p<\/jats:italic>\n \u2009=\u20090.584). Age, sex, polyuria, family history and residence were not significant.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n DKA severity is the strongest independent predictor of prolonged hospital stay in children with new\u2010onset DKA. Ketonuria is a useful bedside marker but lacks independent effect beyond severity. Infection independently predicts faster discharge. These findings could inform risk stratification and resource allocation in similar settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/edm2.70308","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:41:45Z","timestamp":1786538505000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Predictors of Time to Hospital Discharge in Children With New\u2010Onset Diabetic Ketoacidosis in Zambia: A Retrospective Cohort Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1446-1065","authenticated-orcid":false,"given":"Gunet","family":"Mwalungali","sequence":"first","affiliation":[{"name":"School of Medicine Cavendish University Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8730-8410","authenticated-orcid":false,"given":"Blessings","family":"Kaimbo","sequence":"additional","affiliation":[{"name":"School of Medicine Cavendish University Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0730-3795","authenticated-orcid":false,"given":"Martin","family":"Kampamba","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Zambia Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry","family":"Mweetwa","sequence":"additional","affiliation":[{"name":"Ministry of Technology and Science Government of the Republic of Zambia Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Mutati","sequence":"additional","affiliation":[{"name":"School of Medicine Cavendish University Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0078-4675","authenticated-orcid":false,"given":"Chanda","family":"Chisunka","sequence":"additional","affiliation":[{"name":"School of Medicine Cavendish University Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4312-9631","authenticated-orcid":false,"given":"Annie","family":"Silwimba","sequence":"additional","affiliation":[{"name":"School of Applied and Health Sciences, Pharmacy Department Evelyn Hone College of Applied Arts and Commerce Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Hangoma","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, School of Health Sciences Levy Mwanawasa Medical University Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(23)01301\u20106"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13098\u2010025\u201001905\u20103"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12701"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.13406"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010020\u201005152\u20101"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc19\u20100428"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD016214"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12801"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/jcrc.2002.36755"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/pedi\/2550952"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010021\u201004379\u20102"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/81.3.515"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u201013\u201088"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X211063408"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/20503121251343175"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/2333794X241248320"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.4102\/jcmsa.v3i1.200"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871\u2010024\u201002467\u2010z"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12902\u2010026\u201002329\u20104"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010026\u201047"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metop.2025.100370"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0264626"}],"container-title":["Endocrinology, 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