Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Abstract

Background and aim To conduct a systematic literature review and analyze the demographic/biochemical parameters and clinical outcomes of COVID-19 patients with diabetic ketoacidosis (DKA) and combined DKA/HHS (hyperglycemic hyperosmolar syndrome). Methods PubMed, Scopus, Embase, and Google Scholar databases were systematically searched till August 3, 2020 to identify studies reporting COVID-19 patients with DKA and combined DKA/HHS. A total of 19 articles reporting 110 patients met the eligibility criteria. Results Of the 110 patients, 91 (83%) patients had isolated DKA while 19 (17%) had DKA/HHS. The majority of the patients were male (63%) and belonged to black ethnicity (36%). The median age at presentation ranged from 45.5 to 59.0 years. Most of the patients (77%) had pre-existing type 2 diabetes mellitus. Only 10% of the patients had newly diagnosed diabetes mellitus. The median blood glucose at presentation ranged from 486.0 to 568.5 mg/dl, being higher in patients with DKA/HHS compared to isolated DKA. The volume of fluid replaced in the first 24 h was higher in patients with DKA/HHS in contrast to patients with DKA alone. The in-hospital mortality rate was 45%, with higher mortality in the DKA/HHS group than in the isolated DKA group (67% vs. 29%). pH was lower in patients who had died compared to those who were discharged. Conclusion DKA in COVID-19 patients portends a poor prognosis with a mortality rate approaching 50%. Differentiating isolated DKA from combined DKA/HHS is essential as the latter represents nearly one-fifth of the DKA cases and tends to have higher mortality than DKA alone.

Acute Metabolic Emergencies in Diabetes and COVID-19: a systematic review and meta-analysis of case reports

“…Additionally, we demonstrated an independent correlation of mixed DKA/HHS related to COVID-19 infection with non-surviving. Our results are in keeping with the ones reported in the systematic review of Pal et al, who describe a statistically significant difference in arterial blood pH between COVID-19-related DKA survivors (7.23, 95% CI: 7.09-7.26) when compared with non-survivors (7.00, 95% CI: 6.91-7.11); P=0.017 [20]. Despite that data linking increased osmolarity with increased fatality rate in COVID-19 patients are lacking, it is well known that death occurs in 5-16% of patients with HHS in general, a rate that is about 10-fold higher than that reported for DKA [73][74][75].…”

COVID-19 and diabetes mellitus: from pathophysiology to clinical management

“…Although ketoacidosis is typically a problem closely associated with T1DM, in patients with COVID-19, ketoacidosis can also occur in those with T2DM. For example, in a systematic review, 77% of patients with COVID-19 who developed ketoacidosis had T2DM 28 .…”

Can GPR4 Be a Potential Therapeutic Target for COVID-19?

“…In addition to acidotic pH in inflamed and hypoxic tissues, respiratory and metabolic acidosis is a common complication observed in COVID-19 patients, especially in patients with severe disease ( 37 ). Also, COVID-19 may aggravate ketoacidosis in diabetes patients and cause kidney injuries, leading to metabolic acidosis in patients ( 38 – 40 ). As a proton-sensing GPCR, GPR4 is optimally activated under acidic extracellular pH (6.4–6.9) and partially activated at physiological pH 7.4 ( 41 , 42 ).…”