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Stevens JS, Bogun MM, McMahon DJ, et al. Diabetic ketoacidosis and mortality in COVID-19 infection. Diabetes Metab. 2021;47(6):101267doi: 10.1016/j.diabet.2021.101267.
Stevens, J. S., Bogun, M. M., McMahon, D. J., Zucker, J., Kurlansky, P., Mohan, S., Yin, M. T., Nickolas, T. L., & Pajvani, U. B. (2021). Diabetic ketoacidosis and mortality in COVID-19 infection. Diabetes & metabolism, 47(6), 101267. https://doi.org/10.1016/j.diabet.2021.101267
Stevens, J S, et al. "Diabetic ketoacidosis and mortality in COVID-19 infection." Diabetes & metabolism vol. 47,6 (2021): 101267. doi: https://doi.org/10.1016/j.diabet.2021.101267
Stevens JS, Bogun MM, McMahon DJ, Zucker J, Kurlansky P, Mohan S, Yin MT, Nickolas TL, Pajvani UB. Diabetic ketoacidosis and mortality in COVID-19 infection. Diabetes Metab. 2021 Nov;47(6):101267. doi: 10.1016/j.diabet.2021.101267. Epub 2021 Jul 28. PMID: 34332112; PMCID: PMC8317499.
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Diabetes Metab. 2021 Nov;47(6):101267. doi: 10.1016/j.diabet.2021.101267. Epub 2021 Jul 28.

Diabetic ketoacidosis and mortality in COVID-19 infection.

Diabetes & metabolism

J S Stevens, M M Bogun, D J McMahon, J Zucker, P Kurlansky, S Mohan, M T Yin, T L Nickolas, U B Pajvani

Affiliations

  1. Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.
  2. Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.
  3. Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States.
  4. Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States.
  5. Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States. Electronic address: [email protected].
  6. Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States. Electronic address: [email protected].
  7. Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States. Electronic address: [email protected].

PMID: 34332112 PMCID: PMC8317499 DOI: 10.1016/j.diabet.2021.101267

Abstract

AIM: - Patients with diabetes have increased morbidity and mortality from COVID-19. Case reports describe patients with simultaneous COVID-19 and diabetic acidosis (DKA), however there is limited data on the prevalence, predictors and outcomes of DKA in these patients.

METHODS: - Patients with COVID-19 were identified from the electronic medical record. DKA was defined by standardized criteria. Proportional hazard regression models were used to determine risk factors for, and mortality from DKA in COVID-19.

RESULTS: - Of 2366 patients admitted for COVID-19, 157 (6.6%) patients developed DKA, 94% of whom had antecedent type 2 diabetes, 0.6% had antecedent type 1 diabetes, and 5.7% patients had no prior diagnosis of diabetes. Patients with DKA had increased hospital length of stay and in-patient mortality. Higher HbA1c predicted increased risk of incident DKA (HR 1.47 per 1% increase, 95% CI 1.40-1.54). Risk factors for mortality included older age (HR 1.07 per 5 years, 95% CI 1.06-1.08) and need for pressors (HR 2.33, 95% CI 1.82-2.98). Glucocorticoid use was protective in patients with and without DKA.

CONCLUSION: - The combination of DKA and COVID-19 is associated with greater mortality, driven by older age and COVID-19 severity.

Copyright © 2021 Elsevier Masson SAS. All rights reserved.

Keywords: COVID-19; Coronavirus; Diabetic ketoacidosis, DKA; SARS-CoV-2

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