Clinical factors associated with pediatric intensive care unit outcomes in children admitted with diabetic ketoacidosis: a systematic review and meta-analysis comparing newly diagnosed and previously known diabetes

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Diabetic ketoacidosis (DKA) is a serious cause of pediatric intensive care unit (PICU) admission. The current study aims to evaluate the complications and outcomes in pediatric patients admitted to the PICU due to DKA, comparing newly versus previously diagnosed diabetic patients. A comprehensive systematic search was conducted in PubMed, Web of Science, Embase, and Scopus to identify articles published from inception to July 23, 2025. Studies reporting demographic, clinical, and laboratory characteristics, PICU admission outcomes, and complications of pediatric patients (<21 years old) admitted to the PICU with DKA were included. In this systematic review and meta-analysis of 41 studies including 3792 pediatric patients admitted to the PICU with DKA, 53.7% presented with severe DKA, and 58% presented with DKA as the first presentation. The admission findings were vomiting (63%), polydipsia (63%), polyuria (61%), weight loss (43%), tachypnea (42%), loss of consciousness (41%), fever (38%), abdominal pain (32.5%), enuresis (31%), shock (30%), and nausea (25%). The pooled mortality rate was 1%. Acute kidney injury (AKI) was the most common complication (30%). The meta-regression analysis suggested that patients with higher HbA1c and lower HCO3, PCO2, and PH levels were associated with a higher reported incidence of cerebral edema more significantly. Patients with higher glucose or lower HbA1c levels had lower hypoglycemia events. Furthermore, a higher PCO2 level was statistically associated with lower recurrent DKA episodes and higher risk of hypokalemia and AKI. Newly diagnosed patients had higher admission levels of bicarbonate, potassium, and PCO 2 . In contrast, blood ketone levels and the duration of insulin infusion were significantly lower. No significant differences were observed between the two groups in renal function markers, other electrolytes, glycemic indices, neurological status, or length of PICU stay. Pediatric DKA requiring PICU admission is associated with significantly critical morbidity despite low mortality, mostly associated with the acid–base and glycemic parameters. This systematic review was registered in the PROSPERO database (registration number: CRD420261301053).

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