Diabetic Ketoacidosis Raises Risk of In-Hospital Mortality, Hospital Readmission in Heart Failure

Navya Konindala, MD

New data from an analysis of data from more than 100,000,000 million patients with heart failure is providing clinicians with insight into the impact of diabetic ketoacidosis on risk of poor outcomes and complications among patients with heart failure.

Results of the analysis, which levered data from both the National Inpatient Sample (NIS) database and the Nationwide Readmission Database (NRD), indicate diabetic ketoacidosis was associated with a 61% increase in likelihood of in-hospital mortality, 56% increase in likelihood of major adverse cardiovascular events, and a 12% increase in likelihood of 30-day readmission in adjusted analyses.

“Our study concludes that the presence of diabetic ketoacidosis is associated with poor outcomes and increases the risk of complications. The higher rate of readmission in heart failure populations emphasizes the importance of proper post-hospitalization management,” said Navya Konindala, MD, an internal medicine resident with Memorial Healthcare System, during her presentation.

With an interest in assessing the impact of diabetic ketoacidosis on risk of poor outcomes in patients with heart failure, Konindala and colleagues from the Memorial Healthcare System in Pembroke Pines, Florida designed their study as a retrospective cohort analysis of data from the NIS and NRD recorded between 2016 and 2018. Using ICD-10 diagnosis codes to identify patients and a discharge-level weight analysis to produce a national estimate, investigators identified 106,709,435 patients with heart failure and 314,840 with diabetic ketoacidosis for inclusion in their analyses.

Upon analysis, incidence rates for in-hospital mortality (6.52% vs 4.74%), major cardiovascular events (14.77% vs 9.53%), acute kidney injury (60.29% vs 31.06%), deep vein thrombosis (2.52% vs 2.25%) were all greater among those with diabetic ketoacidosis than their counterparts without DKA, but investigators noted patients with diabetic ketoacidosis had a lower prevalence of atrial fibrillation (16.14% vs 27.87%). Additionally, patients with diabetic ketoacidosis were also younger and had a longer mean length of stay (7.51±0.088 vs 6.18±0.004 days) than their counterparts without DKA.

In analyses adjusting for age, sex, race, chronic kidney disease, and comorbid burden, diabetic ketoacidosis was associated with increased in-hospital mortality (OR, 1.61 [95% CI, 1.48-1.74]; P <.0001) and higher incidence of MACE (OR, 1.56 [95% CI, 1.48-1.65]; P <.0001). In analyses assessing risk of readmission, results indicated readmission was more common among those with DKA, with 16.69% of those with diabetic ketoacidosis being readmitted within 30 days compared to 14.72% without diabetic ketoacidosis. In analyses adjusted for age, sex, and CKD, diabetic ketoacidosis was associated with increased likelihood of readmission within 30 days (OR, 1.12 [95% CI, 1.08-1.15]; P <.0001).

“Further studies are needed to untangle the risk factors and develop a standard management of diabetic ketoacidosis in heart failure populations,” added Konindala.

This study, “The Impact of Diabetes Ketoacidosis on Heart Failure: An Analysis of National Inpatient Sample Study 2016-2018,” was presented at AACE 2022.