{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T15:08:15Z","timestamp":1789571295027,"version":"build-2803163510"},"reference-count":38,"publisher":"The Endocrine Society","issue":"5","license":[{"start":{"date-parts":[[2024,7,20]],"date-time":"2024-07-20T00:00:00Z","timestamp":1721433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Audry Newman Rapoport Distinguished Chair in Pediatric Endocrinology"},{"DOI":"10.13039\/100007914","name":"UT Southwestern","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007914","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Develop a multivariable model to identify children with diabetic ketoacidosis (DKA) and\/or hyperglycemic hyperosmolar state (HHS) at increased risk of adverse outcomes and apply it to analyze adverse outcomes during and after the COVID-19 pandemic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Retrospective review of clinical data from 4565 admissions (4284 with DKA alone, 31 [0.7%] only HHS, 250 [5.4%] hyperosmolar DKA) to a large academic children's hospital from January 2010 to June 2023. Data from 2010-2019 (N = 3004) were used as a training dataset, and 2020-2021 (N = 903) and 2022-2023 (N = 658) data for validation. Death or intensive care unit stays &amp;gt;\u202f48 hours comprised a composite \u201cAdverse Outcome\u201d group. Risks for this composite outcome were assessed using generalized estimating equations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 47 admissions with Adverse Outcomes (1.5%) in 2010-2019, 46 (5.0%) in 2020-2021, and 16 (2.4%) in 2022-2023. Eight patients died (0.18%). Maximum serum glucose, initial pH, and diagnosis of type 2 diabetes most strongly predicted Adverse Outcomes. The proportion of patients with type 2 diabetes was highest in 2020-2021. A multivariable model incorporating these factors had excellent discrimination (area under receiver operator characteristic curve [AUC] of 0.948) for the composite outcome in the training dataset, and similar predictive power (AUC 0.960 and 0.873) in the 2020-2021 and 2022-2023 validation datasets, respectively. In the full dataset, AUC for death was 0.984.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Type 2 diabetes and severity of initial hyperglycemia and acidosis are independent risk factors for Adverse Outcomes and explain the higher frequency of Adverse Outcomes during the COVID-19 pandemic. Risks decreased in January 2022 to June 2023.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgae500","type":"journal-article","created":{"date-parts":[[2024,7,20]],"date-time":"2024-07-20T16:49:47Z","timestamp":1721494187000},"page":"e1609-e1618","source":"Crossref","is-referenced-by-count":2,"title":["Risk Factors for Adverse Outcomes in Children With Diabetic Ketoacidosis"],"prefix":"10.1210","volume":"110","author":[{"given":"Maha F","family":"Yousif","sequence":"first","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center , Dallas, TX 75390 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie D","family":"Dolak","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center , Dallas, TX 75390 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