Alroobi Hasan, Dargham Soha, Mahfoud Ziyad, Jayyousi Amin, Al Suwaidi Jassim, Abi Khalil Charbel
Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
Virginia Commonwealth University Health, Richmond, VA, USA.
BMC Cardiovasc Disord. 2025 May 20;25(1):384. doi: 10.1186/s12872-025-04832-3.
Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS) are acute, life-threatening hyperglycemic conditions in diabetes. We aim to assess in-hospital cardiovascular outcomes of DKA and HHS in type 2 diabetes (T2D) patients with heart failure (HF) and compare both complications.
The National Inpatient Sample database was used to gather data on T2D patients admitted for HF (primary diagnosis) from 2008 to 2019. The secondary diagnoses were DKA or HHS. The outcomes investigated were mortality, ischemic stroke, acute renal failure, and cardiogenic shock.
Diabetes HF patients with DKA were younger than those without HHS-DKA, more likely to be females, and had a higher prevalence of coronary artery disease and chronic kidney disease. DKA was associated with higher adjusted risk of mortality (aOR = 2.75[2.42-3.13)], ischemic stroke (aOR = 2.51[1.80-3.49]), acute renal failure (aOR = 1.54[1.45-1.64]), and cardiogenic shock (aOR = 2.53[2.19-2.92]. Diabetes HF patients with HHS were also younger but had more comorbidities than those without HHS-DKA. However, HHS was only associated with an increased adjusted risk of acute renal failure (aOR = 1.59[1.49-1.70]. When both hyperglycemic groups were compared, DKA patients were younger and had fewer comorbidities. However, they had a higher adjusted risk of mortality (aOR = 2.90[2.22-3.79] and cardiogenic shock (aOR = 2.86 [2.13-3.83], but not acute renal failure or stroke.
DKA and HHS are associated with worse cardiovascular outcomes in heart failure patients with type 2 diabetes. Further, when both conditions were compared, the mortality risk and cardiogenic shock were higher in DKA compared to HHS. Implementing tailored fluid and electrolyte management, optimizing insulin protocols, and enhancing monitoring with early intervention could be lifesaving for these high-risk patients.
糖尿病酮症酸中毒（DKA）和高渗高血糖状态（HHS）是糖尿病中急性、危及生命的高血糖病症。我们旨在评估2型糖尿病（T2D）合并心力衰竭（HF）患者中DKA和HHS的院内心血管结局，并比较这两种并发症。
使用国家住院患者样本数据库收集2008年至2019年因HF（主要诊断）入院的T2D患者的数据。次要诊断为DKA或HHS。所调查的结局包括死亡率、缺血性中风、急性肾衰竭和心源性休克。
合并DKA的糖尿病HF患者比未合并HHS-DKA的患者更年轻，女性更常见，冠状动脉疾病和慢性肾病的患病率更高。DKA与更高的调整后死亡风险（aOR = 2.75[2.42 - 3.13]）、缺血性中风（aOR = 2.51[1.80 - 3.49]）、急性肾衰竭（aOR = 1.54[1.45 - 1.64]）和心源性休克（aOR = 2.53[2.19 - 2.92]）相关。合并HHS的糖尿病HF患者也更年轻，但比未合并HHS-DKA的患者有更多合并症。然而，HHS仅与急性肾衰竭的调整后风险增加相关（aOR = 1.59[1.49 - 1.70]）。当比较两个高血糖组时，DKA患者更年轻且合并症更少。然而，他们有更高的调整后死亡风险（aOR = 2.90[2.22 - 3.79]）和心源性休克风险（aOR = 2.86 [2.13 - 3.83]），但急性肾衰竭或中风风险没有增加。
DKA和HHS与2型糖尿病合并心力衰竭患者更差的心血管结局相关。此外，当比较这两种情况时，DKA的死亡风险和心源性休克风险高于HHS。实施量身定制的液体和电解质管理、优化胰岛素方案以及加强监测并进行早期干预对这些高危患者可能是救命的。
