ODP217 Is Major Depressive Disorder in DKA Associated with Worse Patient Outcomes? A National Readmission Database Analysis
Authors: Ramirez Marcelo , Shaka Hafeez , Sandino Gabriela , Aguilera Maria 
Published: November 2022

Abstract

Introduction
Major depressive disorder (MDD) is highly prevalent inpatientswith Diabetes type 1 (DM1),its impact on DKA incidence and outcomes is not well documented. Our goal with this study isto outline the impact of MDD on patients admitted with DKA and compare outcomes with those without comorbid MDD.

Methods
This was a retrospective study involving adult hospitalizations for DKA in patients with T1D in the USA. We extracted data from the Nationwide Readmissions Database (NRD) of 2018. The study involved hospitalizations with DKA as the principal diagnosis in patients with T1D using ICD-10 diagnostic codes (E101). We deemed this as the reason for the index admission. This cohort was grouped based on the presence of a secondary diagnostic code of depressive disorder. Using unique hospitalization identifiers available in the NRD, we identified index hospitalizations, and one subsequent hospitalization within 30 days was tagged as readmission. Outcomes included comparing the 30-day all cause readmission of DKA in patients with and without depressive disorders. We also compared DKA specific readmission in both groups. We compared mortality, mean length of hospital stay (LOS), total hospital charges (THC), and cost of hospitalization (COH) between the groups. We also assessed whether comorbid depressive disorder is an independent predictor for readmission in hospitalizations for DKA.

Results
Of 94,747 patients admitted with DKA, 17.93% had a diagnosis of major depression disorder (MDD). Mean length of hospitalization during initial admission was longer in patients with MDD by 0.5 days in comparison to those without (3.35 vs. 2.84 days; p&lt;0. 001). Mean total hospital charges were higher by US$2,373 in patients with MDD (US$30,604 vs US$28,231; p&lt;0. 001). Mean total hospital cost was also greater in patients with MDD in comparison to those without (US$8,019 vs US$8,019; p&lt;0. 001). Of the total of patients initially admitted, 94,461 were discharged alive and 18,311 (19.35%) were readmitted in the next 30 days. Patients with associated MDD had a higher readmission rate than those without (24. 09% vs. 18.32%; p&lt;0. 01). In hospital mortality during readmission was increased in patients with MDD (0.69% vs 0.24%; p&lt;0. 001) with an aOR of 2.84 (1.98 - 4. 06; p&lt;0. 001). Mean length of hospital stay was also higher in patients with MDD by 0.57 days (0.17-0.96; p&lt;0. 001) and total hospital cost was increased by US$778 (p: 0. 035).

Conclusion
This study showed that patients with MDD admitted for DKA had greater healthcare burden and worse patient outcomes in terms of readmission risk, in-hospital mortality rate and length of hospital stay. Exact factors behind this association are not completely clear and still need to be investigated. An area for future research is assessing if successful MDD diagnosis and management could decrease DKA incidence and improve healthcare and patient burden.
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