Polpichai Natchaya, Saowapa Sakditad, Wattanachayakul Phuuwadith, Danpanichkul Pojsakorn, Tahir Hamza, Abdalla Monzer, Trongtorsak Angkawipa
Department of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois, USA.
Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA.
Proc (Bayl Univ Med Cent). 2024 Jun 3;37(5):742-748. doi: 10.1080/08998280.2024.2356782. eCollection 2024.
Diabetic ketoacidosis (DKA) is a critical diabetic emergency with life-threatening complications. The impact of DKA on hospital outcomes in diabetic patients with infection (CDI) remains unclear.
This retrospective analysis used data from the 2016 to 2020 National Inpatient Survey. Adults with diabetes and CDI were categorized into groups with and without DKA. Hospitalization characteristics, comorbidities, and clinical outcomes were compared. Primary outcomes included mortality, length of stay, and total hospital charges. Secondary outcomes included CDI complications. Multivariate logistic regression analysis was conducted, with values ≤ 0.05 considered statistically significant.
Among 494,664 diabetic patients with CDI, 6130 had DKA. Patients with DKA had significantly higher total hospital charges ($194,824 vs $103,740, < 0.001) and longer length of stay (10.14 vs 6.04 days, < 0.001). After adjusting for confounders, DKA patients had increased odds of mortality (adjusted odds ratio [aOR] 2.07), sepsis (aOR 1.40), septic shock (aOR 1.76), cardiac arrest (aOR 3.24), vasopressor use (aOR 2.01), and mechanical ventilation (aOR 1.96) (all < 0.001).
The presence of DKA significantly elevates hospital burden and CDI complications in diabetic patients. These findings underscore the need for close monitoring and aggressive management of DKA in patients with concurrent CDI to improve outcomes.
糖尿病酮症酸中毒（DKA）是一种严重的糖尿病急症，伴有危及生命的并发症。DKA对合并感染（CDI）的糖尿病患者的医院结局的影响尚不清楚。
这项回顾性分析使用了2016年至2020年全国住院患者调查的数据。患有糖尿病和CDI的成年人被分为有或没有DKA的组。比较了住院特征、合并症和临床结局。主要结局包括死亡率、住院时间和总住院费用。次要结局包括CDI并发症。进行了多因素逻辑回归分析，P值≤0.05被认为具有统计学意义。
在494,664例合并CDI的糖尿病患者中，6130例患有DKA。患有DKA的患者总住院费用显著更高（194,824美元对103,740美元，P<0.001），住院时间更长（10.14天对6.04天，P<0.001）。在调整混杂因素后，DKA患者的死亡几率增加（调整后的优势比[aOR]为2.07）、脓毒症（aOR为1.40）、感染性休克（aOR为1.76）、心脏骤停（aOR为3.24）、血管活性药物使用（aOR为2.01）和机械通气（aOR为1.96）（所有P<0.001）。
DKA的存在显著增加了糖尿病患者的医院负担和CDI并发症。这些发现强调了对合并CDI的患者进行密切监测和积极管理DKA以改善结局的必要性。
