Abstract
Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM), associated with significant mortality. Patients frequently develop a constellation of electrolyte disturbances, including hypocalcemia. We wanted to analyze the in-hospital outcomes of DKA patients with hypocalcemia. Methods: We conducted a retrospective observational study using the National Inpatient Sample (NIS) from 2017 and 2018. Patients with type 1 and 2 DM with a principal diagnosis of DKA were selected and stratified based on the presence of hypocalcemia. The primary outcome was in-hospital mortality. The secondary outcomes included the development of sepsis, acute kidney injury (AKI), Acute respiratory failure(ARF), cerebral edema (CE), length of stay (LOS), and total charges. Confounders were adjusted for using multivariate regression analysis. We included AKI and Sepsis in the multivariate analysis for mortality since hypocalcemia can be seen in both conditions. Results: Out of 379,614 DKA admissions during the study period, 6894(1.8%) had hypocalcemia. When adjusted to patient characteristics, co-morbidities and hospital characteristics, those with hypocalcemia had higher odds of AKI (aOR=1.28, CI=1.13-1.45, p=<0.001), sepsis (aOR=2.88, CI=2.07-4.01, p=<0.001), ARF (aOR=3.23, CI=2.59-4.03, p=<0.001) and CE (aOR=2.51, CI=1.24-5.12, p=0.011) compared to those with only DKA. When adjusted to the occurrence of AKI and sepsis, patients with hypocalcemia and DKA had higher odds of in-hospital mortality (aOR= 2.61, CI=1.47-4.64, p=0.001), longer LOS (+1.01 day, CI 0.79-1.24, p<0.001) and higher total hospital charges (+$14,649, CI $11,442-17,855, p<0.001). Conclusion: Hypocalcemia is associated with increased odds of mortality in patients admitted with DKA and it could be used as a disease severity marker. Further studies need to be done to determine if hypocalcemia in DKA is merely a predictive factor or a direct contributor to increased mortality. Disclosure M. Murthi: None. C. D. Corpuz: None. S. Velagapudi: None. M. Ramirez: None. R. Atluri: None. H. Shaka: None.
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