Endocrinology, diabetes & metabolism · 2026
Clinical Predictors of Time to Hospital Discharge in Children With New-Onset Diabetic Ketoacidosis in Zambia: A Retrospective Cohort Study.
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Mwalungali Gunet, Kaimbo Blessings, Kampamba Martin, Mweetwa Larry, Mutati Christine, Chisunka Chanda, Silwimba Annie, Hangoma Jimmy
Аннотация
BACKGROUND AND AIMS: Diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis is common in low-resource settings and associated with prolonged hospitalisation. We aimed to identify determinants of time to discharge among children with new-onset DKA in Zambia.
METHODS: We conducted a retrospective cohort study of children aged 0-16 years with newly diagnosed T1DM and DKA at the University Teaching Hospital, Lusaka (2018-2023). The primary outcome was time to discharge (days). We used Kaplan-Meier with log-rank 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.
RESULTS: Among 353 children (mean age 8.3 years, SD 4.6), median stay was 5 days (IQR 4-8). Log-rank tests showed significant differences in discharge probability by DKA severity (χ2 = 70.32, p < 0.001) and vomiting (χ2 = 30.35, p < 0.001). In the granulated model, DKA severity was the strongest predictor of delayed discharge (moderate: HR = 0.01, p < 0.001; severe: HR = 0.01, p < 0.001), while infection was associated with faster discharge (HR = 1.51, p < 0.001). Ketonuria lost significance after DKA adjustment (HR = 0.90, p = 0.770), indicating a marker not an independent predictor. The stratified model confirmed PH satisfaction (global test χ2 = 5.62, df = 7, p = 0.584). Age, sex, polyuria, family history and residence were not significant.
CONCLUSIONS: DKA severity is the strongest independent predictor of prolonged hospital stay in children with new-onset 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.
METHODS: We conducted a retrospective cohort study of children aged 0-16 years with newly diagnosed T1DM and DKA at the University Teaching Hospital, Lusaka (2018-2023). The primary outcome was time to discharge (days). We used Kaplan-Meier with log-rank 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.
RESULTS: Among 353 children (mean age 8.3 years, SD 4.6), median stay was 5 days (IQR 4-8). Log-rank tests showed significant differences in discharge probability by DKA severity (χ2 = 70.32, p < 0.001) and vomiting (χ2 = 30.35, p < 0.001). In the granulated model, DKA severity was the strongest predictor of delayed discharge (moderate: HR = 0.01, p < 0.001; severe: HR = 0.01, p < 0.001), while infection was associated with faster discharge (HR = 1.51, p < 0.001). Ketonuria lost significance after DKA adjustment (HR = 0.90, p = 0.770), indicating a marker not an independent predictor. The stratified model confirmed PH satisfaction (global test χ2 = 5.62, df = 7, p = 0.584). Age, sex, polyuria, family history and residence were not significant.
CONCLUSIONS: DKA severity is the strongest independent predictor of prolonged hospital stay in children with new-onset 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.