Hidden in Plain Sight: The Association of Cystic Fibrosis and Diabetic Ketoacidosis- A Nationwide Study

Abstract

BackgroundIn recent times, the relationship between cystic fibrosis (CF) and diabetic ketoacidosis (DKA) has garnered growing interest within the medical community. This study aims to investigate the cardiovascular(CV) outcomes and economic ramifications associated with CF patients with DKA,using the United States National Readmission Database(NRD). Methods and ResultsWe examined data from 2016-2020 and excluded patients under the age of 4, identifying 73,125 hospitalizations for cystic fibrosis (CF). Of these,9.18% (n=6,719) were diagnosed with diabetic ketoacidosis (DKA). The DKA cohort had a higher mean age (43 years,SD-18.5 vs 29 years,SD-16.3;p=0.000). Baseline-comorbidities were shown in Figure1. DKA in CF has been identified as a predictor for all-cause-mortality[OR2.3,95%CI 1.8-3,p= 0.000], Acute kidney Injury(AKI)[OR 2.99,95%CI 2.65-3.37,p=0.000], Congestive-Heart-Failure(CHF)[OR 5.36,95%CI 4.58-6.27,p=0.000], Stroke [OR 4.93,95%CI 2.97-8.18,p=0.000], Myocardial infarction(MI)[OR 5.06,95%CI 3.20-8.00,p=0.000], SCA [OR 2.82,95%CI 1.77-4.49,p=0.000], Mechanical-Circulatory-Support(MCS)[OR 2.00,95%CI 1.07-3.75,p=0.030], Major-adverse-cardiovascular-and-cerebrovascular-events(MACCE)[OR 2.95,95%CI 2.35-3.69, p=0.000], Figure-2. In terms of economic impact, CF patients with DKA experienced a higher average inflation-adjusted hospitalization cost ($113,635-vs-$102,622,p=0.0144). However, the difference in the mean length of hospitalization was not clinically meaningful (7.9-vs-8.4 days,p=0.0137). ConclusionsAdverse CV outcomes and increased mortality in DKA patients with CF are influenced by metabolic stress, electrolyte imbalances, inflammation, co-existing comorbidities, and reduced lung function. These factors heighten the cardiovascular risk, requiring attentive monitoring and management by healthcare providers. Enhanced research efforts are essential to comprehensively understand the CF-DKA relationship, paving the way for more effective strategies to manage cardiovascular risks and improve patient outcomes.