In-patient outcomes of patients with diabetic ketoacidosis and concurrent protein energy malnutrition: A national database study from 2016 to 2017

ABSTRACT

Introduction:

Patients often present to the hospital with a well-known complication of diabetes mellitus, namely diabetic ketoacidosis (DKA). In this study, we assess the clinical outcomes of DKA hospitalizations with and without protein-energy malnutrition (PEM).

Methods:

This was a population-based, retrospective observational study using data gathered from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. Hospitalizations of adults >/ = 18 years old with a principal diagnosis of DKA were obtained using ICD-10 codes and divided into groups based on a secondary diagnosis of PEM. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges (THC), and system-based complications.

Results:

Patients with PEM had a statistically significant difference in the adjusted odds for in-hospital mortality compared to patients without PEM (aOR 1.73, 95% CI: 1.20–2.49, p = 0.004). Patients with DKA and PEM had an increased risk of developing sepsis (aOR 2.99, 95% CI: 2.49–3.58, p < 0.001), septic shock (aOR 3.37, 95% CI: 2.31–4.91, p < 0.001), acute kidney failure (aOR 1.27, 95% CI: 1.17–1.37, p < 0.001), acute respiratory failure (aOR 2.23, 95% CI: 1.83–2.73, p < 0.001), deep vein thrombosis (aOR 1.91, 95% CI: 1.43–2.54, p < 0.001), and pulmonary embolism (aOR 2.36, 95% CI: 1.42–3.94, p = 0.001). Patients with DKA and PEM also had an increased mean THC (aOR 19,200, 95% CI 16,000–22,400, p < 0.001) in US dollars and increased LOS (aOR 2.26, 95% CI 1.96–2.57, p < 0.001) in days when compared to patients without PEM.

Conclusion:

Patients hospitalized for DKA with a secondary diagnosis of PEM within the same admission had a statistically significantly higher in-hospital mortality.

KEYWORDS:

• Diabetic ketoacidosis
• diabetes
• nutrition
• protein energy malnutrition
• outcomes
• national in-patient sample
• mortality

Acknowledgments

There are no acknowlegments for this article.

Declaration of funding

The authors have received no funding with respect to research, authorship, and/or publication of this article.

Declaration of financial/other relationships

The authors have no conflicts of interest.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical Approval

Our institution does not require ethical approval NIS data base studies.

Availability of data and materials

We used and/or analyzed the NIS database 2016 & 2017, available online at:

http://www.hcup-us.ahrq.gov

The NIS is a large publicly available all-payer inpatient care database in the United States, containing data on more than seven million hospital stays yearly. Its large sample size is ideal for developing national and regional estimates and enables analyses of rare conditions, uncommon treatments, and special populations.

Data availability statement

Data for the study was collected from the NIS database, which is a large, publicly available inpatient database containing information for more than 7 million hospital stays per year.⁶ Utilization of the NIS database offers a large sample size which is ideal for analysis and developing national estimates to assess the inpatient population.

Declaration of interest

No potential conflict of interest was reported by the author(s).