Predictors for Adverse Outcomes in Diabetic Ketoacidosis in a Multihospital Health System |
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| Institution: | 1. From the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Ohio.;2. Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Ohio.;3. Cleveland Clinic Section of Biostatistics and Quantitative Health Sciences, Cleveland Clinic Foundation, Ohio.;4. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.;1. From Memorial Healthcare System, Hollywood, Florida;2. Loyola University Medical Center, Maywood, Illinois;3. New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York;4. Massachusetts General Hospital, Boston, Massachusetts.;1. From Metabolic Bone Diseases Service, Endocrine Institute, Meir Medical Center, Kfar Saba, Israel;2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Department of Medical Management, Meir Medical Center, Kfar Saba, Israel;4. Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel;5. Department of Geriatrics, Meir Medical Center, Kfar Saba, Israel;6. Dorot Medical Center for Rehabilitation and Geriatrics, Netanya, Israel;7. Clalit Health Services, Tel Aviv, Israel.;1. From the Department of Pediatrics, Indiana University, Indianapolis, Indiana.;2. Division of Pediatric Endocrinology and Diabetology, Indiana University, Indianapolis, Indiana. |
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| Abstract: | Objective: To determine predictors of prolonged length of stay (LOS), 30-day readmission, and 30-day mortality in a multihospital health system.Methods: We performed a retrospective review of 531 adults admitted with diabetic ketoacidosis (DKA) to a multihospital health system between November 2015 and December 2016. Demographic and clinical data were collected. Linear regression was used to calculate odds ratios (ORs) for predictors and their association with prolonged LOS (3.2 days), 30-day readmission, and 30-day mortality.Results: Significant predictors for prolonged LOS included: intensive care unit (ICU) admission (OR, 2.12; 95% confidence interval CI], 1.38 to 3.27), disease duration (nonlinear) (OR, 1.28; 95% CI, 1.10 to 1.49), non-white race (OR, 1.73; 95% CI, 1.15 to 2.60), age at admission (OR, 1.03; 95% CI, 1.01 to 1.04), and Elixhauser index (EI) (OR, 1.21; 95% CI, 1.13 to 1.29). Shorter time to consult after admission (median Q1, Q3] of 11.3 3.9, 20.7] vs. 14.8 7.4, 37.3] hours, P<.001) was associated with a shorter LOS. Significant 30-day readmission predictors included: Medicare insurance (OR, 2.35; 95% CI, 1.13 to 4.86) and EI (OR, 1.31; 95% CI, 1.21 to 1.41). Endocrine consultation was associated with reduced 30-day readmission (OR, 0.51; 95% CI, 0.28 to 0.92). A predictive model for mortality was not generated because of low event rates.Conclusion: EI, non-white race, disease duration, age, Medicare, and ICU admission were associated with adverse outcomes. Endocrinology consultation was associated with lower 30-day readmission, and earlier consultation resulted in a shorter LOS.Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EI = Elixhauser index; HbA1c = hemoglobin A1c; ICD = International Classification of Diseases; ICU = intensive care unit; LOS = length of stay; OR = odds ratio; Q = quartile |
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