Prognosis of COVID-19 patients with diabetic ketoacidosis with or without hyperosmolar hyperglycemic state

ABSTRACT

Background: One of the risk factors for poor outcome with SARS-CoV-2 infection is diabetes mellitus;diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most serious complications of diabetes mellitus. We aimed to explore the clinical characteristics and outcomes of COVID-19 patients presenting with isolated DKA or combined DKA/HHS to our institution. Methods: A retrospective, hospital based observation case series was performed on patients with SARS-CoV-2 admitted to Intensive Care Unit between 03/20/20 and 04/20/20. Inclusion criteria were 1) Blood Glucose >250mg/dL;2) Serum bicarbonate < 18 mmol/L;3) Anion Gap >10;4) serum pH < 7.3;4) ketonemia or ketonuria;and 5) positive SARS-CoV-2 RT-PCR. Hyperosmolality, on the other hand, was defined as an effective/calculated plasma osmolality >304 mOsm/kg. Results: A total of 87 patients with COVID-19 were admitted to the ICU during the study period, 12 of them had either isolated DKA or DKA/HHS. Baseline demographics, lab values and outcome are summarized in Table 1. Six of the patients had isolated DKA and six had combined DKA and HHS. The median age for the patient was 49.5 years old (range from 19 to 62 years old). The male to female ratio was 51. Of the 12 patients, 10 patients (83%) had a history of DM, nine were type 2 and only one type 1;two patients were newly diagnosed DM, presenting as DKA, presumptively precipitated by COVID-19. Five patients (42%) had a BMI >30 kg/m2. As for ethnicity;seven were Hispanic (59%), four African American (33%), and one Caucasian (8%). Patients with combined DKA/HHS, higher BMI, higher HbA1c, severe acidosis tended to have higher mortality. The striking feature was that isolated DKA or combined DKA/HHS was the initial presentation for COVID-19 for most of the cases. Conclusion: Our observational retrospective case series reinforces the need to watch for new onset DM and monitor blood sugar closely in those with known diabetes mellitus during SARS-CoV-2 infection, in order to avoid such serious complications as DKA and HHS. (Table Presented).