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Santharaman A, Raj K, Sankaramangalam K, Dewan S, Sapkota S, Chandna S, Shah M, Singh D, Bassi M, Luo H, Redel H. COVID-19 Related Predisposition to Diabetic Ketoacidosis. Cureus 2023; 15:e36674. [PMID: 37102024 PMCID: PMC10124755 DOI: 10.7759/cureus.36674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 04/28/2023] Open
Abstract
Background and aims Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can exacerbate hyperglycemia and can cause life-threatening diabetic ketoacidosis (DKA) in patients with diabetes mellitus (DM). The objective of this study is to compare the characteristics of diabetic COVID-19 patients with and without DKA and to determine the predictors of mortality in the setting of COVID-19 and DKA. Methods This is a retrospective single-center cohort study including patients admitted to our hospital with COVID-19 and DM from March 2020 to June 2020. Patients with DKA were filtered as per the diagnostic criteria set by the American Diabetes Association (ADA). Patients with hyperosmolar hyperglycemic state (HHS) were excluded. A retrospective analysis was performed, which included those who developed DKA and those with neither DKA nor HHS. The primary outcome measurement was mortality rate and predictors of mortality for DKA. Results Out of 301 patients with COVID-19 and DM, 30 (10%) had DKA and five (1.7%) had HHS. Mortality was significantly higher in the DKA group compared to the non-DKA/HHS group (36.6% vs 19.5%; OR: 2.38; p=0.03). After adjusting for parameters used for multivariate logistic model for mortality, DKA was no longer associated with mortality (OR: 2.08, p=0.35). The independent predictors for mortality were age, platelet count, serum creatinine, C-reactive protein, hypoxic respiratory failure, need for intubation, and need for vasopressors. Conclusion Our study demonstrates higher mortality rate in diabetic COVID-19 patients with DKA. Though direct and independent statistical association of mortality with DKA could not be proven in our multivariate logistic model, physicians must be vigilant in risk-stratifying and managing these patients in a timely manner.
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Affiliation(s)
| | - Kavin Raj
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Kesavan Sankaramangalam
- Internal Medicine, Rutgers Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, USA
| | - Sandesh Dewan
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Saroj Sapkota
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Sanya Chandna
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Monarch Shah
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Dhruv Singh
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Mehak Bassi
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Hongxiu Luo
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Henry Redel
- Infectious Disease, Saint Peter's University Hospital, New Brunswick, USA
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