Prevalence and Prognostic Impact of Rhabdomyolysis in Adults Hospitalized with Diabetic Ketosis: A 10-Year Single-Centre Cohort Study

Objective To determine the prevalence and clinical impact of rhabdomyolysis (RML) among adults hospitalized with diabetic ketosis. Design Ten-year retrospective single-centre cohort study. Methods We reviewed adults admitted with diabetic ketosis, including isolated ketosis and diabetic ketoacidosis (2015–2024). RML was defined as peak creatine kinase >1,000 U/L; patients with confirmed acute myocardial infarction were excluded. The primary endpoint was a composite poor outcome, defined as in-hospital death or discharge against medical advice (DAMA) due to critical illness with a grave prognosis. Predictors of poor outcome were assessed using Firth-corrected multivariable logistic regression. Results Of 920 eligible patients, 18 (1.96%) developed RML. Compared with controls, patients with RML were older and more likely to have neurological comorbidities, recent falls, impaired consciousness, infection, effective serum osmolality > 320 mOsm/kg, leukocytosis, higher C-reactive protein, elevated creatinine, acute kidney injury, markedly raised myoglobin and elevated troponin I. RML was associated with longer hospital stay, higher costs, higher in-hospital mortality (11.1% vs 0.67%) and a higher rate of the composite poor outcome (16.7% vs 1.11%). Leukocytosis (>9.5×10^9/L; adjusted OR 4.29, 95% CI 1.35–14.37, P=0.014) and troponin I >0.03 ng/mL (adjusted OR 5.79, 95% CI 1.56–21.86, P=0.009) independently predicted poor outcome. Conclusions RML is an uncommon but important complication of diabetic ketosis, conferring higher short-term mortality, healthcare use and composite poor outcome. Routine screening for RML and concurrent inflammatory or cardiac injury provides a crucial window for early risk stratification, enabling clinicians to optimize therapeutic strategies and resource use for high-risk individuals.