PSUN194 Inpatient Outcomes of Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
Authors: Silgado Maria Laura Ricardo , Apoorva Tangri , Tarhoni Imad , Bagar Darin , Hasan Muqdad , Kubbar Alaa , Karnik Suruchi , Iwuala Sandra , Trusty Rhonda-Kaye , Aroyewun Opeyemi , Rashmi Prama , Bhusal Sandhya , Rippe Edward , Hamid Hashmi Syed Salman , Tahir Muhammad , Mahalli Joseph , Gorbonos Allen , Kamat Arnav , Bahtiyar Gul , Rodriguez Giovanna 
Published: November 2022

Abstract

Introduction
Hyperosmolar crisis, which includes diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), is a severe and acute complication of diabetes. The estimated mortality rates of DKA and HHS are 6.8% and 10%, respectively (Benoit, Zhang, Geiss, Gregg, & Albright, 2018) (Pasquel & Umpierrez, 2014). There is limited evidence regarding the clinical characteristics, hospital complications, and mortality rate of patients with combined DKA and HHS. Therefore, we aim to compare hospital outcomes between patients with DKA, HHS, and combined DKA and HHS in a community hospital in Brooklyn, NY.

Methodology
We performed a retrospective analysis from the patients admitted for DKA and/or HHS at Health+Hospitals / Woodhull from 2019 to 2021. Descriptive statistics were used to determine the frequency of patients in each hyperglycemic group and their clinical characteristics. Using one-way ANOVA and Chi-square test, we compared the demographics and clinical outcomes between subgroups. Multivariate regression analysis and log-rank test were used to assess the influence of multiple variables on hospital mortality and the difference in survival between groups, respectively.

Results
We studied 263 patients admitted for a hyperglycemic crisis, DKA (58%), HHS (14%), and DKA+HHS (28%). Baseline characteristics of the population include male (60%), African American (42%), Hispanic (32%), and mean BMI of 28±8 kg/m2. No difference was found in mean admission HbA1c (DKA 12±2.6%, HHS 12.7±3%, DKA+HHS 12.7±2.5%, p: 0.08). Patients with HHS were older (mean age 56±15) compared with DKA (47±17) and DKA+HHS (49±18). Patients with DKA+HHS had higher mean admission blood sugar (893±330 mg/dL), compared with DKA (497±206 mg/dL) and HHS (808±346 mg/dL) (p &lt;0.001). There was no difference in the frequency of hypokalemia, K+ &lt;3.5 mEq/L (DKA 26.9%, HHS 6.3%, DKA+HHS 12.6%, p: 0.8); hypoglycemia (DKA 12%, HHS 4.6%, DKA+HHS 7%, p: 0.2); or cerebral edema (DKA 0.8%, HHS 0.4%, DKA+HHS 1.5%, p: 0.1) between the groups. However, the frequency of acute kidney injury (AKI) was higher in DKA (24.7%) than in HHS (7%) or DKA+HHS (16.7%) (p: 0.034). There was no difference in the mean days of hospital stay (DKA 8.5±28, HHS 7±8, DKA+HHS 8±10, p: 0.9) and in-hospital mortality (DKA 3.4%, HHS 3.5%, DKA+HHS 4%, p: 0.069) among the groups. In all subtypes of hyperglycemic crisis, the mortality rate was significantly higher with older age, presence of AKI, cerebral edema, and vasopressor requirement.

Conclusions
There was no significant difference in mortality, length of admission, prevalence of hypoglycemia, hypokalemia, and cerebral edema between the three groups. The prevalence of AKI was significantly higher in DKA compared with HHS and DKA+HHS. Older age, presence of AKI, cerebral edema, and vasopressor requirement were mortality predictors among hyperglycemic crisis.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.