Comparing outcomes of diabetic ketoacidosis hospitalisations in patients with diastolic heart failure: A retrospective propensity matched analysis of the nationwide inpatient sample

Diabetes Metab Res Rev. 2021 Oct;37(7):e3435. doi: 10.1002/dmrr.3435. Epub 2021 Jan 26.


Introduction: Diabetic ketoacidosis (DKA) is a known complication of patients with diabetes mellitus. The aim of this study was to compare the outcomes of patients admitted with a diagnosis of DKA with, and without, diastolic heart failure (DHF).

Methods: This was a population-based, retrospective, observational study using data from the National Inpatient Sample database for the years 2016 and 2017. The primary outcome was in-hospital mortality. Secondary outcomes were rates of sepsis, non-ST elevation myocardial infarctions (NSTEMI), acute kidney failure, acute respiratory failure (ARF), deep vein thrombosis, pulmonary embolism, mean length of hospital stay (LOS) and total hospital charges (THC).

Results: There was no statistically significant difference for the adjusted odds for in-hospital mortality between patients with and without DHF (adjusted odds ratio [aOR]: 0.55, 95% confidence interval [CI] 0.28-1.08, p = 0.081). Patients with DKA and DHF had increased odds of developing an NSTEMI (aOR: 1.31, 95% CI: 1.01-1.70, p = 0.045) or ARF (aOR: 1.82, 95% CI: 1.38-2.40, p < 0.001) during the same admission compared to patients without DHF. Patients with DKA and DHF also had an increased mean THC (6500 CI: 1900-11,200, p = 0.0006) in US dollars and increased LOS (0.7, 95% CI: 0.2-1.3, p = 0.011) in days when compared to patients without DHF.

Conclusions: Patients with DKA showed no statistically significant difference in mortality if they did or did not have a secondary diagnosis of DHF within the same admission.

Keywords: cardiovascular diseases; diabetes mellitus; diabetic ketoacidosis; diastolic heart failure; mortality.

Publication types

  • Observational Study

MeSH terms

  • Diabetes Mellitus*
  • Diabetic Ketoacidosis* / complications
  • Diabetic Ketoacidosis* / epidemiology
  • Heart Failure, Diastolic*
  • Hospitalization
  • Humans
  • Inpatients
  • Retrospective Studies