Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis

Abstract

Background The increasing prevalence of diabetic ketoacidosis (DKA) related admissions poses a significant burden on the healthcare systems globally. However, data regarding the predictors of healthcare resource utilization in DKA is limited and inconsistent. This study aimed to identify key predictors of hospital length of stay (LOS), readmission and recurrent DKA episodes. Methods We undertook a retrospective cross-sectional analysis of all DKA admissions from 2015 to 2021 across four hospitals in Qatar. The primary outcomes were the length of stay (LOS), 90-day readmission and 6-month and 1-year DKA recurrence. Results We included 922 patients with a median age of 35 years (25–45). 62% were males with type-1 diabetes-mellitus (T1DM) and type-2 DM (T2DM), present in 52% and 48% of patients. The median LOS was 2.6 days (IQR 1.1–4.8), and the median DKA resolution time was 18 h (10.5–29). Male-gender, new-onset DM, higher Charlson Comorbidity Index (CCI), lower haemoglobin, sodium and potassium, higher urea, longer DKA duration and MICU admission predicted a longer LOS in a multivariate regression analysis. None of the factors were significantly associated with 90-day readmission. Patients with pre-existing T1DM were more likely to have a six-month DKA recurrence than pre-existing T2DM. Patients with a 6-month DKA recurrence, female gender and T1DM had higher odds of 12-month recurrence, whereas a consult with a diabetes educator at the index admission was associated with decreased odds of recurrence. Conclusions/interpretation This is the most extensive study from the Middle-East region reporting on LOS, readmissions and the recurrence of DKA. Results from this study with a diverse population may be valuable for physicians and healthcare systems to decrease the diabetes-related healthcare burden in DKA patients.

Clinical nomogram prediction model to assess the risk of prolonged ICU length of stay in patients with diabetic ketoacidosis: a retrospective analysis based on the MIMIC-IV database

“…To our knowledge, this is the first risk prediction model for prolonged ICU LOS in patients with DKA. This distinguishes our study from previous research [ 7 , 10 ] that primarily focused on identifying factors influencing LOS in patients with DKA. In this study we simultaneously screened multiple variables using LASSO, enhancing the precision of the final inclusion in the nomogram.…”

“…The length of hospitalisation in patients with DKA may be influenced by their prognosis. Ata et al [ 7 ] showed that patients with DKA with longer hospitalisation periods are at a higher risk of comorbidities, leading to a poor prognosis, further increasing the economic burden, and creating a vicious circle. Patients with DKA treated in general wards have been reported to exhibit no significant difference in mortality rate but had lower treatment costs compared to patients with DKA admitted to the ICU [ 8 , 9 ].…”

“…Previous studies have shown that several factors influence LOS in patients with DKA. However, a highly sensitive and specific predictive model to assess ICU LOS in patients with DKA is lacking [ 7 , 10 ]. Therefore, this study aimed to develop a nomogram prediction model to identify the risk factors influencing prolonged ICU LOS in patients with DKA.…”

Diabetic Ketoacidosis in Northern Jordan: Seasonal Morbidity and Characteristics of Patients

“… 33 It may also indicate how poorly controlled diabetes over the preceding months of acute presentation affects the general health of diabetic patients which leads to a more protracted stay in hospital. 34 …”

Diabetes and Ramadan Fasting (2023): The Year in Review

“…Ata et al examined the differences in the number of DKA episodes during Ramadan compared to the rest of the year in patients with T1D and T2D in Qatar with view to examine the seasonality of DKA between 2015 and 2021. 41 Of 922 patients, 52% had T1D and 48% had T2D. The median age was 35 years.…”