Diabetic ketoacidosis in patients with type 2 diabetes: Risk factors for mortality and adverse outcomes

Table 1 Comorbidities of type 2 diabetes patients admitted with diabetic ketoacidosis

Comorbidity	Number of cases	Prevalence (%)
COPD	96	20.69
AKI	80	17.24
Cerebrovascular disease	69	14.87
Congestive heart failure	39	8.41
Cancer	35	7.54
Acute MI	31	6.68
Peptic ulcer	29	6.25
Dementia	28	6.03
Hypertension	21	4.53
Peripheral vascular disease	18	3.88
Metastatic cancer	11	2.37
Rheumatoid arthritis	11	2.37
Mild liver disease	7	1.51

COPD: Chronic obstructive pulmonary disease; AKI: Acute kidney injury; MI: Myocardial infarction.

Table 2 Baseline clinical and laboratory parameters

Lab parameter	Mean (SD)	Median (25th-75th percentiles)
HbA1c (mmol/mol)	89.5 (30)	88.5 (51-130)
NEWS 2 score	3.6 (3)	5 (3-15)
Potassium	3.6 (0.7)	3.6 (3.2-4.0)
eGFR	56.4 (26.5)	56.5 (34-85.3)
Systolic BP	106 (21)	103 (95-114)
pH	7.2 (0.2)	7.3 (7.1-7.3)

HbA1c: Glycated hemoglobin; NEWS: National early warning score; eGFR: Estimated glomerular filtration rate; BP: Blood pressure.

Table 3 Predictors of length of hospital stay

Predictor	Coefficient	95%CI	P value	Interpretation
Intercept	-19.14	(-110.98 to 72.70)	0.679	Baseline length of stay (reference group)
Cerebrovascular disease	6.75	(0.76 to 12.74)	0.028	Adds about 6.7 days to LOS
Those who were on SGLT-2 inhibitors	5.80	(1.32 to 9.62)	0.035	Adds about 5.8 days to LOS
COPD	3.60	(2.14 to 6.44)	0.04	Adds about 3.6 days to LOS
Higher NEWS 2 score	1.14	(0.10 to 2.18)	0.033	Each NEWS 2 point adds about 1.14 days to LOS
Systolic BP	-0.18	(-0.32 to -0.04)	0.014	Lower systolic BP predicts longer LOS
Acute myocardial infarction	-6.06	(-12.15 to 0.03)	0.051	Shortens LOS by about 6 days (only borderline significance as P > 0.05 and confidence interval crosses 0)

NEWS: National early warning score; BP: Blood pressure; SGLT: Sodium glucose co-transporter; LOS: Length of stay; COPD: Chronic obstructive pulmonary disease.

Table 4 Logistic regression analysis examining the risk factors for inpatient mortality

Predictor	Coefficient	Std. error	P value	95%CI	Odds ratio
Congestive heart failure	3.43	0.989	0.001	1.49 to 5.37	30.83
Peripheral vascular disease	3.84	1.288	0.003	1.31 to 6.36	46.43
Use of metformin pre-admission	-2.39	0.71	0.001	-3.78 to -0.99	0.09
Minimum eGFR value (indicating baseline kidney function)	-0.023	0.011	0.038	-0.044 to -0.001	0.98

eGFR: Estimated glomerular filtration rate.

Table 5 Logistic regression analysis examining the risk factors for 30-day mortality

Predictor	Coefficient	Std. error	P value	95%CI	Odds ratio
Intercept	-3.92	1.452	0.007	-6.77 to -1.08	0.02
IMD decile (deprivation index)	-0.31	0.104	0.003	-0.51 to -0.10	0.74
Age	0.058	0.02	0.003	0.020 to 0.097	1.06
Minimum eGFR value	-0.033	0.012	0.005	-0.057 to -0.010	0.97

eGFR: Estimated glomerular filtration rate; IMD: Index of multiple deprivation.

Table 6 Cox proportional hazards model analysis examining the long-term mortality risk after index hospitalisation

Predictor	Coefficient	Exp (coefficient)	Std. error	95%CI	P value
Age	0.04	1.04	0.01	0.02 to 0.06	< 0.005
Use of metformin	1.89	6.62	0.53	0.85 to 2.93	< 0.005
Use of sulfonylureas	2.13	8.39	0.66	0.83 to 3.42	< 0.005
Cerebrovascular disease	-1.08	0.34	0.44	-1.94 to -0.22	0.01
Dementia	3.02	20.54	0.67	1.72 to 4.33	< 0.005