tetano
Editor, Senior Moderator
Cureus
. 2021 Jan 30;13(1):e13000.
doi: 10.7759/cureus.13000.
COVID-19 and Diabetic Ketoacidosis: A Single Center Experience
Balraj Singh[SUP] 1 [/SUP], Parminder Kaur[SUP] 2 [/SUP], Prem Patel[SUP] 2 [/SUP], Ro-Jay Reid[SUP] 3 [/SUP], Abhishek Kumar[SUP] 4 [/SUP], Supreet Kaur[SUP] 1 [/SUP], Nirmal Guragai[SUP] 2 [/SUP], Abanoub Rushdy[SUP] 2 [/SUP], Mahesh Bikkina[SUP] 2 [/SUP], Fayez Shamoon[SUP] 2 [/SUP]
Affiliations
Abstract
Background and objectives: To describe the clinical characteristics and outcomes of hospitalized coronavirus disease 2019 (COVID-19) patients with diabetic ketoacidosis (DKA) -- a single center tertiary hospital experience.
Materials and methods: A retrospective study was conducted among patients admitted to our hospital in the United States between March 1[SUP]st [/SUP]and June 15[SUP]th[/SUP], 2020 with DKA and severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection known as COVID-19. We compared the baseline characteristics, laboratory data, and clinical course between survivors and nonsurvivors to identify the risk factors associated with mortality in the patients with DKA.
Results: A total number of 43 patients were included in this study. The median age was 52 years. Thirty-three (76.7%) patients were male. Median value of initial glucose on presentation was 553 mg/dL (300.0-1927.0 mg/dL). On admission, 33 (76.7%) patients had glycated hemoglobin (HbA1c) ≥ 8% (64 mmol/mol) and HbA1c was not obtained in 10 (23.3%) patients. Acute kidney injury (AKI) was seen in 37 (86.0%) patients, 6 (14%) patients required renal replacement therapy and 22 (51.2%) required mechanical ventilation. Among the 43 patients, 25 (58.1%) died. Out of 25 patients who died 15 (60.0%) were Hispanics, 6 (24.0%) were White, 3 (12.0%) were African American, 1 (4%) was Arabic, and 1 (4%) was Asian. The patients who died were older in age than who survived (mean age 58 ? 6.13 vs 46 ? 9.39; p = 0.023). Some 95% of the patients requiring mechanical ventilation died (odds ratio [OR]: 89.25; 95% confidence interval [CI]: 9.10-874.96); p = 0.001). Compared to survivors, nonsurvivors had significantly higher d-dimer (13.00 ? 3.20 mcg/mL vs 6.15 ? 3.66 mcg/mL; p< 0.006) and peak ferritin values (2763.66 ? 1105.32 ng/mL vs 835.16 ? 257.07 ng/mL; p= 0.016). Conclusion: Our retrospective study shows COVID-19 infection may present as DKA in patients with diabetes mellitus (DM). Older age, mechanical ventilation, elevated d-dimer, and ferritin are associated with poor prognosis in these patients. Our study shows that COVID-19 is associated with substantial mortality in DKA patients and adds to the limited literature available regarding poor risk factors associated with mortality in these patients.
Keywords: covid-19; diabetes type 2; diabetic ketoacidosis (dka); dka; hyperglycemic crisis; hyperglycemic hyperosmolar non-ketotic syndrome; sars-cov-2 (severe acute respiratory syndrome coronavirus -2); severe acute respiratory syndrome-coronavirus-2; type i diabetes mellitus.
. 2021 Jan 30;13(1):e13000.
doi: 10.7759/cureus.13000.
COVID-19 and Diabetic Ketoacidosis: A Single Center Experience
Balraj Singh[SUP] 1 [/SUP], Parminder Kaur[SUP] 2 [/SUP], Prem Patel[SUP] 2 [/SUP], Ro-Jay Reid[SUP] 3 [/SUP], Abhishek Kumar[SUP] 4 [/SUP], Supreet Kaur[SUP] 1 [/SUP], Nirmal Guragai[SUP] 2 [/SUP], Abanoub Rushdy[SUP] 2 [/SUP], Mahesh Bikkina[SUP] 2 [/SUP], Fayez Shamoon[SUP] 2 [/SUP]
Affiliations
- PMID: 33542884
- PMCID: PMC7847783
- DOI: 10.7759/cureus.13000
Abstract
Background and objectives: To describe the clinical characteristics and outcomes of hospitalized coronavirus disease 2019 (COVID-19) patients with diabetic ketoacidosis (DKA) -- a single center tertiary hospital experience.
Materials and methods: A retrospective study was conducted among patients admitted to our hospital in the United States between March 1[SUP]st [/SUP]and June 15[SUP]th[/SUP], 2020 with DKA and severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection known as COVID-19. We compared the baseline characteristics, laboratory data, and clinical course between survivors and nonsurvivors to identify the risk factors associated with mortality in the patients with DKA.
Results: A total number of 43 patients were included in this study. The median age was 52 years. Thirty-three (76.7%) patients were male. Median value of initial glucose on presentation was 553 mg/dL (300.0-1927.0 mg/dL). On admission, 33 (76.7%) patients had glycated hemoglobin (HbA1c) ≥ 8% (64 mmol/mol) and HbA1c was not obtained in 10 (23.3%) patients. Acute kidney injury (AKI) was seen in 37 (86.0%) patients, 6 (14%) patients required renal replacement therapy and 22 (51.2%) required mechanical ventilation. Among the 43 patients, 25 (58.1%) died. Out of 25 patients who died 15 (60.0%) were Hispanics, 6 (24.0%) were White, 3 (12.0%) were African American, 1 (4%) was Arabic, and 1 (4%) was Asian. The patients who died were older in age than who survived (mean age 58 ? 6.13 vs 46 ? 9.39; p = 0.023). Some 95% of the patients requiring mechanical ventilation died (odds ratio [OR]: 89.25; 95% confidence interval [CI]: 9.10-874.96); p = 0.001). Compared to survivors, nonsurvivors had significantly higher d-dimer (13.00 ? 3.20 mcg/mL vs 6.15 ? 3.66 mcg/mL; p< 0.006) and peak ferritin values (2763.66 ? 1105.32 ng/mL vs 835.16 ? 257.07 ng/mL; p= 0.016). Conclusion: Our retrospective study shows COVID-19 infection may present as DKA in patients with diabetes mellitus (DM). Older age, mechanical ventilation, elevated d-dimer, and ferritin are associated with poor prognosis in these patients. Our study shows that COVID-19 is associated with substantial mortality in DKA patients and adds to the limited literature available regarding poor risk factors associated with mortality in these patients.
Keywords: covid-19; diabetes type 2; diabetic ketoacidosis (dka); dka; hyperglycemic crisis; hyperglycemic hyperosmolar non-ketotic syndrome; sars-cov-2 (severe acute respiratory syndrome coronavirus -2); severe acute respiratory syndrome-coronavirus-2; type i diabetes mellitus.