Incidence, Predictors and Outcomes of Cerebral Edema Among Patients With Diabetic Ketoacidosis (DKA) From Nationwide Inpatient Sample (NIS) 2002-2015

Abstract

Introduction: Cerebral edema is the leading cause of death in patients admitted with diabetic ketoacidosis. The osmolar gradient caused by the high blood glucose results in water shift from the intracelluar fluid (ICF) to the extracellular fluid (ECF) space and contraction of cell volume.There is limited data regarding the national incidence, predictors, and outcomes of cerebral edema among patients with diabetic ketoacidosis (DKA). Methods: Data derived from Nationwide Inpatient Sample (NIS) were analyzed for years 2002-2015. Adult Hospitalizations with primary diagnosis of DKA were identified using International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9 CM) code 250.1 x. Only adult hospitalisations were incuded in study. Cerebral edema patients were identified using ICD-9 CM code 348.5. We utilized Cochrane Armitage trend test to analyze temporal trends and multivariate survey regression to analyze outcomes. Statastical Anlysis Software (SAS) 9.4 verson used for statistical analsyis. Results: Overall out of 2,008,106 DKA hospitalization, 933 (0.04%) developed cerebral edema, which estimates the incidence of cerebral edema at 0.4/1000. Trends of incidence of developing cerebral edema increased from 0.01 in 2002 to 0.1 in 2015 (P < 0.001). Univariate analysis showed that in-hospital mortality was very high among those who developed cerebral edema (21.55% Vs. 0.57%; P < 0.001). In multivariate analysis after adjusting for confounders, cerebral edema was associated with higher in-hospital mortality (aOR 4.39, 95% confidence interval [CI] 2.89-6.67; P < 0.001) and discharge to facility (aOR 1.61, 95% CI 1.02-2.54; P <0 .001). Predictors of developing cerebral edema were increasing age (aOR 1.13, 95%CI 1.03-1.24; P <0 .001), Hyperkalemia (aOR 2.24, 95%CI 1.49-3.35; P <0 .001) and Septicemia (aOR 5.24, 95%CI 3.24-8.48; P < 0.001). Conclusion: Our study shows that over the study period, incidence of cerebral edema among DKA patients has increased and were found to have worst outcomes. In-Depth studies are warrented to depict the outcomes and predictors of cerebral edema in DKA patients in future.