Incidence and outcomes of diabetic ketoacidosis in hospitalized adults with COVID-19: A retrospective cohort study

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Rationale COVID-19 has varied clinical manifestations. Limited data suggests that diabetic ketoacidosis (DKA) in COVID-19 patients is associated with greater mortality than in non-COVID-19 patients. We hypothesized that COVID-19 patients with DKA would have increased mortality than those without DKA.Objectives To evaluate the association between DKA and mortality in hospitalized adults with COVID-19.Methods We conducted a single-center, retrospective cohort study of 2812 hospitalized adults with COVID-19 at Los Angeles General Medical Center between January 2020 and March 2021. We utilized ICD-10 codes to identify patients with DKA. Univariate analyses (Wilcoxon rank sum, Chi-square or Fisher’s exact test) and multivariate Cox and Poisson regression with prespecified covariates were performed to evaluate the effect of DKA on the primary outcome of time to hospital mortality and the secondary outcome of 90-day hospital-free days.Measurements and Main Results A total of 72 (2.6%) of COVID-19 patients had DKA. In-hospital mortality rate was 31.9% for those with DKA and 12.0% for those without. Median 90-day hospital free days was 79.5 and 86.0 for those with and without DKA, respectively. After correcting for confounders, there was no significant difference in time to mortality between patients with and without DKA (HR = 1.30, 95% CI = 0.89-2.10, p = 0.16). However, patients with DKA had significantly fewer hospital-free days within the first 90 days (rate ratio = 0.92, 95% CI = 0.89-0.95, p < 0.001).Conclusions We did not detect an association between the development of DKA and increased mortality in COVID-19 patients.

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