Outcomes in hospitalised diabetic ketoacidosis patients with underlying heart failure: a national inpatient sample analysis

Abstract

Abstract Management of diabetic ketoacidosis (DKA) is challenging in patients with heart failure as they tend to be fluid sensitive. We conducted this study to assess the impact of heart failure (HF) on in-hospital outcomes in patients hospitalized with DKA. We conducted this cohort study using the national inpatient sample database from 2017 and 2018. The International Classification of Diseases-10 codes were used to identify patients with DKA as the principal diagnosis and stratified them based on whether they had HF. The outcomes were in-patient mortality, length of stay, total hospital charges, and complications during the hospitalization. We used multivariate regression analysis to adjust for confounders. Among the 446,339 total hospitalized for DKA, 20,210 had a secondary diagnosis of HF. The average age was 57 (HF) vs 38 (no HF) (p<0.001). In the HF group, 56% were male and 56% were caucasian. After adjusting for patient demographics, comorbidities, and hospital characteristics, patients with HF had higher odds of cardiogenic shock (aOR=3.77, p<0.001, CI: 1.89–7.49), pneumonia (aOR=1.37, p<0.001, CI: 1.18–1.60), Total hospital charges (coefficient= $5,894.20, p<0.001, CI: 3046–8741) and length of stay (coefficient 0.35 days, p=0.001, CI: 0.14–0.56). There was no statistically significant difference in mortality, cardiac arrest, and sepsis. Patients with HF had lower odds of developing acute kidney injury (aOR=0.66, p<0.001, 0.62–0.72). Among hospitalized patients with DKA, those with HF had worse outcomes in terms of length of stay, total hospital charges, cardiogenic shock, and pneumonia. However, there was no statistically significant increase in inpatient mortality. Funding Acknowledgement Type of funding sources: None.