Kings County Hospital - New York City Health and Hospitals, Department of Emergency Medicine, USA; State University of New York Health Sciences University, Department of Emergency Medicine, USA.
Kings County Hospital - New York City Health and Hospitals, Department of Emergency Medicine, USA; State University of New York Health Sciences University, Department of Emergency Medicine, USA.
Diabetes Metab Syndr. 2022 Jan;16(1):102389. doi: 10.1016/j.dsx.2022.102389. Epub 2022 Jan 7.
Describe the prevalence/outcomes of Diabetic Ketoacidosis (DKA) patients comparing pre- (March-April 2019) and pandemic (March-April 2020) periods.
Retrospective cohort of admitted pandemic DKA/COVID-19+ patients comparing prevalence/outcomes to pre-pandemic DKA patients that takes place in Eleven hospitals of New York City Health & Hospitals. Our included participants during the pandemic period were admitted COVID-19+ patients (>18 years) and during the pre-pandemic period were admissions (>18 years) selected through the medical record. We excluded transfers during both periods. The intervention was COVID-19+ by PCR testing. The main outcome measured was mortality during the index hospitalization and secondary outcomes were demographics, medical histories and triage vital signs, and laboratory tests. Definition of DKA: Beta-Hydroxybutyrate (BHBA) (>0.4 mmol/L) and bicarbonate (<15 mmol/L) or pH (<7.3).
Demographics and past medical histories were similar during the pre-pandemic (n = 6938) vs. pandemic (n = 7962) periods. DKA prevalence was greater during pandemic (3.14%, 2.66-3.68) vs. pre-pandemic period (0.72%, 0.54-0.95) (p > 0.001). DKA/COVID-19+ mortality rates were greater (46.3% (38.4-54.3) vs. pre-pandemic period (18%, 8.6-31.4) (p < 0.001). Surviving vs. non-surviving DKA/COVID-19+ patients had more severe DKA with lower bicarbonates by 2.7 mmol/L (1.0-4.5) (p < 0.001) and higher both Anion Gaps by 3.0 mmol/L (0.2-6.3) and BHBA by 2.1 mmol/L (1.2-3.1) (p < 0.001).
COVID-19 increased the prevalence of DKA with higher mortality rates secondary to COVID-19 severity, not DKA. We suggest DKA screening all COVID-19+ patients and prioritizing ICU DKA/COVID-19+ with low oxygen saturation, blood pressures, or renal insufficiency.
描述比较糖尿病酮症酸中毒（DKA）患者在流行前（2019 年 3 月至 4 月）和大流行期间（2020 年 3 月至 4 月）的患病率/结局。
这是一项回顾性队列研究，纳入了在纽约市健康与医院系统的 11 家医院住院的大流行期间的 DKA/COVID-19+患者，并与流行前 DKA 患者的患病率/结局进行比较。我们纳入的大流行期间的参与者为 PCR 检测阳性的 COVID-19+（>18 岁）患者，而流行前的参与者为通过病历选择的（>18 岁）住院患者。我们排除了两个时期的转院患者。干预措施为 COVID-19+。主要结局是指数住院期间的死亡率，次要结局为人口统计学特征、既往病史和分诊生命体征以及实验室检查。DKA 的定义为：β-羟丁酸（BHBA）（>0.4mmol/L）和碳酸氢盐（<15mmol/L）或 pH 值（<7.3）。
流行前（n=6938）与大流行期间（n=7962）患者的人口统计学特征和既往病史相似。大流行期间 DKA 的患病率更高（3.14%，2.66-3.68），而流行前期间的患病率较低（0.72%，0.54-0.95）（p>0.001）。DKA/COVID-19+的死亡率更高（46.3%（38.4-54.3）vs. 流行前（18%，8.6-31.4）（p<0.001）。与 DKA/COVID-19+幸存患者相比，非幸存患者的 DKA 更为严重，碳酸氢盐低 2.7mmol/L（1.0-4.5）（p<0.001），阴离子间隙高 3.0mmol/L（0.2-6.3）和 BHBA 高 2.1mmol/L（1.2-3.1）（p<0.001）。
COVID-19 增加了 DKA 的患病率，死亡率更高继发于 COVID-19 的严重程度，而非 DKA。我们建议对所有 COVID-19+患者进行 DKA 筛查，并优先对低氧饱和度、血压或肾功能不全的 ICU 中 DKA/COVID-19+患者进行治疗。
