Rate and Predictors of 30-day Readmission Following Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A US Analysis
Rate and Predictors of 30-day Readmission Following Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A US Analysis
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DOI：
10.1210/clinem/dgab372
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发表时间：
2021-05-27
影响因子：
5.8
通讯作者：
Kichloo, Asim
中科院分区：
文献类型：
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作者：
Shaka, Hafeez;Aguilera, Maria;Kichloo, Asim
背景：糖尿病酮症酸中毒（DKA）是一种严重的内分泌急症，与发病率和死亡率相关。再入院在美国的医疗费用负担中发挥着重要但有时是可以预防的作用。目的：本研究旨在描述因DKA住院的1型糖尿病（T1 DM）成人患者非选择性30天再入院的比率和特征，并确定再入院的预测因素。使用国际疾病分类第十版临床修改代码对T1 DM患者的DKA住院进行分类。我们利用卡方检验比较再入院和指数住院之间的基线特征。采用多变量考克斯回归分析确定再入院的独立预测因素。在此之后，我们开发了一个30天的再入院风险评分系统的基础上独立predictors.Results：30天的全因再入院率为DKA为19.4%。大多数患者（64.8%）在再入院时的主要诊断为DKA。再次入院患者的平均年龄（35.3 vs 34.9岁，P= 0.018）和女性比例（52.8 vs 49.6%，P<0.001）明显高于指数入院患者。DKA后再次入院与住院死亡率较高相关（0.69 vs 0.24%，OR 2.84，95%CI 1.99-4.06，P<0.001）。30天全因再入院的独立预测因素包括女性、Charlson Comorbid Index（CCI）评分≥ 3的指标住院、以及违背医嘱出院（AMA）。结论：T1 DM患者因DKA再入院率较高，且大多数患者以DKA为再入院的主要诊断。CCI等于或大于3、高血压、女性和出院时AMA是再入院的重要预测因素。
Context: Diabetic ketoacidosis (DKA) is a serious endocrine emergency, associated with morbidity and mortality. Readmissions play a significant but sometimes preventable role in healthcare cost burden on the US.Objective: This study aimed to describe rates and characteristics of nonelective 30-day readmission among adult patients with diabetes mellitus type 1 (T1DM) hospitalized for DKA and also identify predictors of readmission.Methods: The study analyzed the 2018 Nationwide Readmission Database. DKA hospitalizations in patients with T1DM were classified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. We utilized chi-squared tests to compare baseline characteristics between readmissions and index hospitalizations. Multivariable Cox regression was employed to identify independent predictors of readmission. Following this, we developed a 30-day readmission risk scoring system based on independent predictors.Results: The 30-day all-cause readmission rate for DKA was 19.4%. A majority of patients (64.8%) had DKA as the principal diagnosis on readmission. Readmitted patients had a significantly higher mean age (35.3 vs 34.9 years, P= .018) and a higher proportion of females (52.8 vs 49.6%, P< .001) than the index admission. Readmission following DKA was associated with higher odds of inpatient mortality (0.69 vs 0.24%, OR 2.84, 95% CI 1.99-4.06, P< .001). Independent predictors of 30-day all-cause readmission included female sex, index hospitalizations with Charlson Comorbidity Index (CCI) score of 3 or greater, and being discharged against medical advice (AMA).Conclusion: The readmission rate for DKA in T1DM patients is high, and most patients have DKA as the principal diagnosis on readmission. A CCI equal to or greater than 3, hypertension, female sex, and being discharged AMA were significant predictors of readmission.