THU352 Troponin Elevation On The Outcomes Of Hospitalized Patients With Diabetic Ketoacidosis: Analysis Of National Inpatient Sample
Authors: Karki Sadichhya , Gajjar Rohan , Krishnaraju Ellil , Soon-Shiong Raquel , Jamshed Aneeza 
Published: October 2023

Disclosure: S. Karki: None. R. Gajjar: None. E. Krishnaraju: None. R. Soon-Shiong: None. A. Jamshed: None.

Background: Cardiac troponins are preferred biomarkers for acute myocardial infarction, however, its role in prognosis of patients with Diabetic Ketoacidosis (DKA) is still not well-established. We aim to compare the clinical outcomes of patients admitted for DKA with and without Acute Myocardial Infarction (AMI). Methods: Data was extracted from the National Inpatient Sample (NIS) 2020 Database. Adults admitted with a principal diagnosis of DKA were identified and further stratified based on presence of secondary diagnosis of Acute Myocardial Infarction (AMI) using International Classification of Diseases -10 codes. AMI includes ST elevation MI (STEMI) , Non ST elevation MI (NSTEMI) and MI type 2 along with nonspecific ones. The primary outcomes assessed were inpatient mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes include inpatient complications (sepsis, acute kidney injury (AKI), acute respiratory failure (ARF), need for mechanical ventilation (MV), intubation, and vasopressors). Multivariate logistic and linear regression analyses were used to adjust for possible confounders and to analyze the outcomes. Results: A total of 206,315 adult patients were hospitalized with DKA out of which 4,575 (2.21%) had evidence of AMI in the form of troponin elevation. The majority were middle aged (45-65 years) with a mean age of 60 years, half of them were females, and more than 50% patients had coexisting dyslipidemia and coronary artery disease. Our analysis revealed that patients who were hospitalized with DKA and developed AMI were associated with significantly higher adjusted odds of inpatient mortality (aOR 4.61, 95%CI 3.15-6.77,p&lt;0.001), increased mean LOS by 1.62 days (95% CI 1.09-2.14, p&lt;0.001), and higher mean THC ($39,883, 95% CI 29,921-49,845, p&lt;0.001). Additionally complications such as sepsis(aOR 3.03 , 95%CI 2.26-4.06), AKI(aOR 2.15, 95%CI 1.83-2.54), ARF(aOR 3.03, 95%CI 2.45-3.75), need for MV(aOR 4.04, 95%CI 3.15-5.17), intubation(aOR 3.64, 95%CI 2.80-4.76), and vasopressors support(aOR 3.53, 95%CI 2.11-5.89) were significantly higher in DKA patients who had AMI compared to patients without AMI. Conclusion: It is well established that the presence of poorly controlled diabetes increases patients’ risk for cardiovascular events including AMI. Troponin elevation can occur in patients with DKA in the absence of CAD. This arises due to myocardial necrosis from factors such as severe acidosis, concomitant infection, and significant dehydration leading to supply/demand mismatch etc. Regardless, patients with troponin elevation admitted for DKA have increased mortality ,longer hospital stay, increased total hospital charges along with several inpatient complications compared to those without any evidence of troponin elevation.

Presentation: Thursday, June 15, 2023