Which factors predict readmission for DKA in T1DM patients?

A US study has found a high rate of readmission for diabetic ketoacidosis (DKA) in patients with type 1 diabetes mellitus (T1DM), most of whom have DKA as the principal diagnosis. Moreover, a Charlson Comorbidity Index (CCI) score of ≥3, female sex, hypertension, and being discharged against medical advice are significantly associated with readmission.

The authors analysed the 2018 Nationwide Readmission Database and classified DKA hospitalizations with T1DM using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. They also used chi-squared tests to compare baseline characteristics between readmissions and index hospitalizations.

Additionally, the authors performed a multivariable Cox regression analysis to identify independent predictors of readmission and subsequently developed a 30-day readmission risk scoring system based on these predictors.

The rate of all-cause readmission for DKA at 30 days was 19.4 percent, with majority of the patients (64.8 percent) having DKA as the principal diagnosis on readmission. Readmitted patients had a significantly higher mean age (35.3 vs 34.9 years; p=0.018) and a higher proportion of females (52.8 percent vs 49.6 percent; p<0.001) than the index admission.

Readmission following DKA contributed to a higher likelihood of inpatient mortality (0.69 percent vs 0.24 percent; odds ratio, 2.84, 95 percent confidence interval, 1.99–4.06; p<0.001). Thirty-day all-cause readmission was independently predicted by female sex, index hospitalization with CCI score ≥3, and being discharged against medical advice.

“DKA is a serious endocrine emergency, associated with morbidity and mortality,” the authors said. “Readmissions play a significant but sometimes preventable role in healthcare cost burden on the US.”