Department of Clinical & Experimental Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK.
Department of Diabetes & Endocrinology, Surrey & Sussex Healthcare NHS Trust, Redhill, UK.
Diabetes Obes Metab. 2023 Jul;25(7):2012-2022. doi: 10.1111/dom.15076. Epub 2023 Apr 25.
To investigate characteristics of people hospitalized with coronavirus-disease-2019 (COVID-19) and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS), and to identify risk factors for mortality and intensive care admission.
Retrospective cohort study with anonymized data from the Association of British Clinical Diabetologists nationwide audit of hospital admissions with COVID-19 and diabetes, from start of pandemic to November 2021. The primary outcome was inpatient mortality. DKA and HHS were adjudicated against national criteria. Age-adjusted odds ratios were calculated using logistic regression.
In total, 85 confirmed DKA cases, and 20 HHS, occurred among 4073 people (211 type 1 diabetes, 3748 type 2 diabetes, 114 unknown type) hospitalized with COVID-19. Mean (SD) age was 60 (18.2) years in DKA and 74 (11.8) years in HHS (p < .001). A higher proportion of patients with HHS than with DKA were of non-White ethnicity (71.4% vs 39.0% p = .038). Mortality in DKA was 36.8% (n = 57) and 3.8% (n = 26) in type 2 and type 1 diabetes respectively. Among people with type 2 diabetes and DKA, mortality was lower in insulin users compared with non-users [21.4% vs. 52.2%; age-adjusted odds ratio 0.13 (95% CI 0.03-0.60)]. Crude mortality was lower in DKA than HHS (25.9% vs. 65.0%, p = .001) and in statin users versus non-users (36.4% vs. 100%; p = .035) but these were not statistically significant after age adjustment.
Hospitalization with COVID-19 and adjudicated DKA is four times more common than HHS but both associate with substantial mortality. There is a strong association of previous insulin therapy with survival in type 2 diabetes-associated DKA.
研究因 2019 年冠状病毒病（COVID-19）和糖尿病酮症酸中毒（DKA）或高渗高血糖状态（HHS）住院的患者的特征，并确定死亡和入住重症监护病房的风险因素。
回顾性队列研究，使用英国临床糖尿病学家协会对 2021 年 11 月大流行期间因 COVID-19 和糖尿病住院的患者进行全国性审计的匿名数据。主要结局为住院死亡率。根据国家标准判断 DKA 和 HHS。使用逻辑回归计算年龄调整后的优势比。
在因 COVID-19 住院的 4073 例患者（114 例未知类型）中，共确诊 85 例 DKA 病例和 20 例 HHS。DKA 的平均（SD）年龄为 60（18.2）岁，HHS 为 74（11.8）岁（p<0.001）。HHS 患者中，非白种人比例高于 DKA 患者（71.4% vs. 39.0%，p=0.038）。DKA 的死亡率为 36.8%（n=57），2 型和 1 型糖尿病分别为 3.8%（n=26）。在 2 型糖尿病合并 DKA 的患者中，与非使用者相比，胰岛素使用者的死亡率较低[21.4% vs. 52.2%；年龄调整后的优势比 0.13（95% CI 0.03-0.60）]。DKA 的粗死亡率低于 HHS（25.9% vs. 65.0%，p=0.001），他汀类药物使用者的死亡率低于非使用者（36.4% vs. 100%；p=0.035），但在年龄调整后，差异无统计学意义。
COVID-19 住院并确诊 DKA 比 HHS 常见四倍，但两者均与较高的死亡率相关。2 型糖尿病相关 DKA 中，既往胰岛素治疗与生存密切相关。
