The impact of COVID-19 on Diabetic Ketoacidosis patients.
Coronavirus disease 19
Covid-19
Critical care
Diabetes
Diabetic ketoacidosis
Emergency medicine
Infectious disease
dka
Journal
Diabetes & metabolic syndrome
ISSN: 1878-0334
Titre abrégé: Diabetes Metab Syndr
Pays: Netherlands
ID NLM: 101462250
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
10
11
2021
revised:
03
01
2022
accepted:
04
01
2022
pubmed:
12
1
2022
medline:
26
2
2022
entrez:
11
1
2022
Statut:
ppublish
Résumé
Describe the prevalence/outcomes of Diabetic Ketoacidosis (DKA) patients comparing pre- (March-April 2019) and pandemic (March-April 2020) periods. Retrospective cohort of admitted pandemic DKA/COVID-19+ patients comparing prevalence/outcomes to pre-pandemic DKA patients that takes place in Eleven hospitals of New York City Health & Hospitals. Our included participants during the pandemic period were admitted COVID-19+ patients (>18 years) and during the pre-pandemic period were admissions (>18 years) selected through the medical record. We excluded transfers during both periods. The intervention was COVID-19+ by PCR testing. The main outcome measured was mortality during the index hospitalization and secondary outcomes were demographics, medical histories and triage vital signs, and laboratory tests. Definition of DKA: Beta-Hydroxybutyrate (BHBA) (>0.4 mmol/L) and bicarbonate (<15 mmol/L) or pH (<7.3). Demographics and past medical histories were similar during the pre-pandemic (n = 6938) vs. pandemic (n = 7962) periods. DKA prevalence was greater during pandemic (3.14%, 2.66-3.68) vs. pre-pandemic period (0.72%, 0.54-0.95) (p > 0.001). DKA/COVID-19+ mortality rates were greater (46.3% (38.4-54.3) vs. pre-pandemic period (18%, 8.6-31.4) (p < 0.001). Surviving vs. non-surviving DKA/COVID-19+ patients had more severe DKA with lower bicarbonates by 2.7 mmol/L (1.0-4.5) (p < 0.001) and higher both Anion Gaps by 3.0 mmol/L (0.2-6.3) and BHBA by 2.1 mmol/L (1.2-3.1) (p < 0.001). COVID-19 increased the prevalence of DKA with higher mortality rates secondary to COVID-19 severity, not DKA. We suggest DKA screening all COVID-19+ patients and prioritizing ICU DKA/COVID-19+ with low oxygen saturation, blood pressures, or renal insufficiency.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Describe the prevalence/outcomes of Diabetic Ketoacidosis (DKA) patients comparing pre- (March-April 2019) and pandemic (March-April 2020) periods.
METHODS
METHODS
Retrospective cohort of admitted pandemic DKA/COVID-19+ patients comparing prevalence/outcomes to pre-pandemic DKA patients that takes place in Eleven hospitals of New York City Health & Hospitals. Our included participants during the pandemic period were admitted COVID-19+ patients (>18 years) and during the pre-pandemic period were admissions (>18 years) selected through the medical record. We excluded transfers during both periods. The intervention was COVID-19+ by PCR testing. The main outcome measured was mortality during the index hospitalization and secondary outcomes were demographics, medical histories and triage vital signs, and laboratory tests. Definition of DKA: Beta-Hydroxybutyrate (BHBA) (>0.4 mmol/L) and bicarbonate (<15 mmol/L) or pH (<7.3).
RESULTS
RESULTS
Demographics and past medical histories were similar during the pre-pandemic (n = 6938) vs. pandemic (n = 7962) periods. DKA prevalence was greater during pandemic (3.14%, 2.66-3.68) vs. pre-pandemic period (0.72%, 0.54-0.95) (p > 0.001). DKA/COVID-19+ mortality rates were greater (46.3% (38.4-54.3) vs. pre-pandemic period (18%, 8.6-31.4) (p < 0.001). Surviving vs. non-surviving DKA/COVID-19+ patients had more severe DKA with lower bicarbonates by 2.7 mmol/L (1.0-4.5) (p < 0.001) and higher both Anion Gaps by 3.0 mmol/L (0.2-6.3) and BHBA by 2.1 mmol/L (1.2-3.1) (p < 0.001).
CONCLUSIONS
CONCLUSIONS
COVID-19 increased the prevalence of DKA with higher mortality rates secondary to COVID-19 severity, not DKA. We suggest DKA screening all COVID-19+ patients and prioritizing ICU DKA/COVID-19+ with low oxygen saturation, blood pressures, or renal insufficiency.
Identifiants
pubmed: 35016042
pii: S1871-4021(22)00003-0
doi: 10.1016/j.dsx.2022.102389
pmc: PMC8736268
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
102389Informations de copyright
Copyright © 2022 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Références
Acta Diabetol. 2010 Sep;47(3):193-9
pubmed: 19333547
JAMA Netw Open. 2021 Mar 1;4(3):e211091
pubmed: 33688962
J Diabetes Investig. 2020 Sep;11(5):1303-1306
pubmed: 32779868
MMWR Morb Mortal Wkly Rep. 2020 Apr 03;69(13):382-386
pubmed: 32240123
Aging (Albany NY). 2020 Apr 8;12(7):6049-6057
pubmed: 32267833
Diabetes Res Clin Pract. 2020 Aug;166:108291
pubmed: 32615280
West J Emerg Med. 2021 May 25;22(3):599-602
pubmed: 34125033
Diabetes Res Clin Pract. 2020 Jul;165:108263
pubmed: 32531325
Metabolism. 2020 Sep;110:154301
pubmed: 32589899
Diabetes. 2004 Aug;53(8):2079-86
pubmed: 15277389
J Endocrinol Invest. 2020 Jun;43(6):867-869
pubmed: 32222956
Diabet Med. 2021 Jan;38(1):e14417
pubmed: 33020999
J Med Virol. 2020 Oct;92(10):1875-1883
pubmed: 32441789
Clin Gastroenterol Hepatol. 2020 Aug;18(9):2128-2130.e2
pubmed: 32334082
MMWR Morb Mortal Wkly Rep. 2018 Mar 30;67(12):362-365
pubmed: 29596400
Diabetes Metab Syndr. 2020 Nov-Dec;14(6):1563-1569
pubmed: 32853901
Diabetes Obes Metab. 2020 Oct;22(10):1935-1941
pubmed: 32314455
Diabet Med. 2016 Feb;33(2):252-60
pubmed: 26286235
Eur Respir J. 2020 May 14;55(5):
pubmed: 32217650
Diabetes Metab Syndr. 2020 Jul - Aug;14(4):535-545
pubmed: 32408118