Background and objectives: To describe the clinical characteristics and outcomes of hospitalized coronavirus disease 2019 (COVID-19) patients with diabetic ketoacidosis (DKA) — a single center tertiary hospital experience. Materials and Methods: A retrospective study was conducted among patients admitted to our hospital in the United States between March 1 st and June 15 th , 2020 with DKA and severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection known as COVID-19. We compared the baseline characteristics, laboratory data, and clinical course between survivors and nonsurvivors to identify the risk factors associated with mortality in the patients with DKA. Results: A total number of 43 patients were included in this study. The median age was 52 years. Thirty-three (76.7%) patients were male. Median value of initial glucose on presentation was 553 mg/dL (300.0-1927.0 mg/dL). On admission, 33 (76.7%) patients had glycated hemoglobin (HbA1c) ≥ 8% (64 mmol/mol) and HbA1c was not obtained in 10 (23.3%) patients. Acute kidney injury (AKI) was seen in 37 (86.0%) patients, 6 (14%) patients required renal replacement therapy and 22 (51.2%) required mechanical ventilation. Among the 43 patients, 25 (58.1%) died. Out of 25 patients who died 15 (60.0%) were Hispanics, 6 (24.0%) were White, 3 (12.0%) were African American, 1 (4%) was Arabic, and 1 (4%) was Asian. The patients who died were older in age than who survived (mean age 58 ± 6.13 vs 46 ± 9.39; p = 0.023). Some 95% of the patients requiring mechanical ventilation died (odds ratio [OR]: 89.25; 95% confidence interval [CI]: 9.10-874.96); p = 0.001). Compared to survivors, nonsurvivors had significantly higher d-dimer (13.00 ± 3.20 mcg/mL vs 6.15 ± 3.66 mcg/mL; p< 0.006) and peak ferritin values (2763.66 ± 1105.32 ng/mL vs 835.16 ± 257.07 ng/mL; p= 0.016). Conclusion: Our retrospective study shows COVID-19 infection may present as DKA in patients with diabetes mellitus (DM). Older age, mechanical ventilation, elevated d-dimer, and ferritin are associated with poor prognosis in these patients. Our study shows that COVID-19 is associated with substantial mortality in DKA patients and adds to the limited literature available regarding poor risk factors associated with mortality in these patients.
【저자키워드】 COVID-19, severe acute respiratory syndrome-coronavirus-2, DKA, sars-cov-2 (severe acute respiratory syndrome coronavirus -2), diabetic ketoacidosis (dka), hyperglycemic hyperosmolar non-ketotic syndrome, hyperglycemic crisis, type i diabetes mellitus, diabetes type 2, 【초록키워드】 coronavirus disease, SARS-CoV-2, Hospitalized, Mortality, mechanical ventilation, Clinical characteristics, hospital, Infection, ferritin, outcome, risk factor, Kidney injury, Retrospective study, Clinical course, AKI, Survivors, COVID-19 infection, male, Patient, age, hemoglobin, Admission, African American, patients, Glucose, renal replacement therapy, Odds ratio, Asian, Diabetic, Older, 95% confidence interval, baseline characteristics, median age, laboratory data, poor prognosis, white, single center, material, survivor, Arabic, initial, identify, died, the patient, the United State, required, elevated, conducted, significantly higher, survived, nonsurvivor, patients with diabete, 【제목키워드】 experience, center,