John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA.
Central Michigan University, College of Medicine, Saginaw, MI, USA.
J Clin Endocrinol Metab. 2021 Aug 18;106(9):2592-2599. doi: 10.1210/clinem/dgab372.
Diabetic ketoacidosis (DKA) is a serious endocrine emergency, associated with morbidity and mortality. Readmissions play a significant but sometimes preventable role in healthcare cost burden on the US.
This study aimed to describe rates and characteristics of nonelective 30-day readmission among adult patients with diabetes mellitus type 1 (T1DM) hospitalized for DKA and also identify predictors of readmission.
The study analyzed the 2018 Nationwide Readmission Database. DKA hospitalizations in patients with T1DM were classified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. We utilized chi-squared tests to compare baseline characteristics between readmissions and index hospitalizations. Multivariable Cox regression was employed to identify independent predictors of readmission. Following this, we developed a 30-day readmission risk scoring system based on independent predictors.
The 30-day all-cause readmission rate for DKA was 19.4%. A majority of patients (64.8%) had DKA as the principal diagnosis on readmission. Readmitted patients had a significantly higher mean age (35.3 vs 34.9 years, P = .018) and a higher proportion of females (52.8 vs 49.6%, P < .001) than the index admission. Readmission following DKA was associated with higher odds of inpatient mortality (0.69 vs 0.24%, OR 2.84, 95% CI 1.99-4.06, P < .001). Independent predictors of 30-day all-cause readmission included female sex, index hospitalizations with Charlson Comorbidity Index (CCI) score of 3 or greater, and being discharged against medical advice (AMA).
The readmission rate for DKA in T1DM patients is high, and most patients have DKA as the principal diagnosis on readmission. A CCI equal to or greater than 3, hypertension, female sex, and being discharged AMA were significant predictors of readmission.
糖尿病酮症酸中毒（DKA）是一种严重的内分泌急症，与发病率和死亡率有关。再入院在美国医疗保健费用负担方面起着重要但有时可预防的作用。
本研究旨在描述因 DKA 住院的 1 型糖尿病（T1DM）成年患者的非选择性 30 天再入院率，并确定再入院的预测因素。
本研究分析了 2018 年全国再入院数据库。使用国际疾病分类第 10 次修订版临床修正码对 T1DM 患者的 DKA 住院进行分类。我们使用卡方检验比较再入院和指数住院的基线特征。采用多变量 Cox 回归确定再入院的独立预测因素。在此基础上，我们根据独立预测因素建立了 30 天再入院风险评分系统。
DKA 的 30 天全因再入院率为 19.4%。大多数患者（64.8%）在再入院时的主要诊断为 DKA。与指数入院相比，再入院患者的平均年龄（35.3 岁比 34.9 岁，P=0.018）更高，女性比例（52.8%比 49.6%，P<0.001）更高。与 DKA 后再入院相关的是住院死亡率更高（0.69%比 0.24%，OR 2.84，95%CI 1.99-4.06，P<0.001）。30 天全因再入院的独立预测因素包括女性、Charlson 合并症指数（CCI）评分等于或大于 3 的指数住院和未经医嘱出院（AMA）。
T1DM 患者 DKA 的再入院率较高，大多数患者再入院时的主要诊断为 DKA。CCI 等于或大于 3、高血压、女性和 AMA 出院是再入院的显著预测因素。
