Mortality Higher for Diabetic Ketoacidosis with COVID-19
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Patients with diabetic ketoacidosis (DKA) with COVID-19 have a much higher rate of mortality than patients without COVID-19, according to a research.

In a comparison of hospitalized DKA patients from February to September 2020, 30% of those who also had COVID-19 died in the hospital, as compared with 5% of those who didn't have COVID-19, reported researchers of Emory University School of Medicine in Atlanta.

In-hospital mortality also varied according to age, they stated. For patients over 65 years, inpatient mortality was 45% for those with COVID-19 versus 13% without. In patients younger than 45 years, these rates were 19% versus 2%, respectively.

Patients with COVID-19 had a three times higher rate of acute kidney injury during an episode of DKA, at 30% versus 10% among those without COVID-19, the researchers reported.

The cohort study included data from the Glytec national database of patients from 175 hospitals across 17 states. A total of 210 patients with DKA tested positive for COVID-19 and they were compared with 4,819 patients with DKA but negative for COVID-19. All patients were admitted to the hospital for DKA and confirmed as having a bicarbonate on admission below 18 mEq/L, a blood glucose over 250 mg/dL, and anion gap over 12 mEq/L. The average age of the cohort was 47 and 53% were men.

All patients were treated with the same computerized continuous insulin infusion algorithm, but those who received insulin treatment for less than 4 hours were excluded.

Upon admission, metabolic parameters -- including glucose levels, HbA1c, potassium, sodium, bicarbonate, and anion gap -- were similar between patients regardless of COVID-19 status. Also, both groups had similar proportions of hypoglycemia, hypokalemia, and hyperosmolality.

However, those who tested positive for COVID-19 tended to be older and had a higher BMI than negative patients. And those who tested positive and who were also over 65 were more likely to have cardiovascular disease, along with diabetes-related complications like nephropathy, neuropathy, or retinopathy.

COVID-19 patients required more insulin -- 5 versus 3.6 units per hour -- and also had a prolonged duration of continuous insulin infusions of 34 hours versus 23 hours for COVID-19-negative patients. Positive patients also had, on average, a longer time to DKA resolution, at 5.8 hours versus 4.4 hours, to achieve a blood glucose under 250 mg/dL.

The researchers stated that they don't exactly know what the root cause of this higher mortality rate in the COVID-19-positive population with DKA is, but called it "worrisome" and an issue that needs more investigation. However, they suggested that contributing factors may include obesity and a more severe state of stress that requires more insulin.