(1296) Mortality Trends in Critically Ill Diabetic Ketoacidosis Hospitalizations: A Population-Based Study

Introduction: The impact of the COVID-19 pandemic on temporal trends of mortality among non COVID-19 critically ill diabetic ketoacidosis (DKA) patients were not clear.

Methods: We used publicly available, deidentified, and statewide data to conduct a population-based cohort study of hospitalizations aged ≥ 18 years with a diagnosis of DKA admitted to ICU at acute care hospitals in in Texas during 2026 - 2022. Hospitalizations with a diagnosis of COVID-19 were excluded. The study population was identified using ICD-10-CM codes selected from Clinical Classification Software Refined category END003: Diabetes melitus with complications. Short-term mortality was defined as in-hospital mortality or discharge to a hospice. The response variables are pre-pandemic time trend, level change, change in time trend, and final time trend. The analysis method is interrupted time series analysis (ITSA) based on multilevel logistic regression with results reported as average marginal effects per quarter and 95% confidence intervals (AME [95% CI]) in changes to the absolute probability of mortality. The matched pairs t-test was applied to ITSA and counterfactual predicted probabilities to further elucidate the impact of the COVID-19 pandemic.

Results: A total of 157,498 hospitalizations were included in the study of which 65,351 (41.5%) occurred after the beginning of the pandemic. Unadjusted short-term mortality was lower in the pre-pandemic period compared to the post-pandemic period (3.9% vs 5.4%). On adjusted analysis, the post-pandemic period remained associated with higher mortality rates. The pre-pandemic short-term mortality time trend was negative (AME -0.05% / quarter, 95% CI [-0.08% to -0.03%], p < 0.0001). The change in time trend was (AME 0.11% / quarter, 95% CI [0.07% to 0.16%], p < 0.0001) and the change in level was also positive (AME 1.4%, 95% CI [1.06% to 1.75%], p < 0.0001). The final time trend was significant (AME 0.06% / quarter, 95% CI [0.02% to 0.09%], p < 0.0001). The estimate and 95% CI for the difference between ITSA predicted and counterfactual predicted probabilities of mortality was 2.04% (2.01% to 2.07%).

Conclusions: The probability of short-term mortality among critically ill non-COVID-19 DKA hospitalizations increased by 2% following the pandemic and had not subsided as of 2022Q4.