COVID-19 and Diabetic Ketoacidosis: A Single Center Experience

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 1st and June 15th, 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 HbA1cwas 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