Mortality twice as likely with early DKA readmission
medwireNews: Readmission to hospital within a month of admission for diabetic ketoacidosis (DKA) is common and associated with an increased mortality risk, say researchers.
As reported at the virtual ENDO 2021 meeting, the team used the US National Readmission Database to identify 91,625 people with type 1 diabetes admitted to hospital for DKA between January and November 2017.
Of the 91,401 people who were discharged alive, 20.2% were readmitted within 30 days, primarily for DKA.
Presenter Hafeez Shaka (John H Stroger Jr Hospital of Cook County, Chicago, Illinois, USA) reported that these readmissions were associated with a significant 2.06-fold increased mortality rate compared with first/single admissions.
In addition, people who were readmitted had a significantly longer length of stay, by an average of 1 day, and they had significantly higher hospital costs.
Multivariate Cox regression analysis revealed that women were a significant 1.14-fold more likely than men to be readmitted, and people discharged against medical advice had a 1.54-fold increased risk for readmission.
Three comorbidities were also significantly associated with an increased likelihood of readmission, namely, hypertension, chronic kidney disease, and anemia, at fold increases of 1.28, 1.13, and 1.42, respectively.
Conversely, obesity and hyperlipidemia were associated with significant 30% and 8% reductions in readmission risk, respectively.
Shaka said it was not clear why these factors were linked to a decreased risk, but he noted the tendency of exogenous insulin use to result in weight gain, and that this cohort of people with type 1 diabetes was on the whole relatively slim. He therefore suggested that obesity could be a marker of greater insulin use, and therefore fewer complications associated with poor glycemic control.
Overall Shaka concluded: “Our recommendations include that efforts should be channeled towards identifying predictors in these patients during their index admission as a way of reducing the rate of readmission, and hence reducing the subsequent patient morbidity and mortality.”
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