Key result
Obesity hypoventilation syndrome in DKA patients linked to ~79% higher in-hospital mortality.
Why the study?
The effect of comorbid obesity hypoventilation syndrome (OHS) on hospitalized patients with diabetic ketoacidosis (DKA) has not been previously studied.
Does comorbid obesity hypoventilation syndrome increase in-hospital mortality and adverse outcomes in patients hospitalized with diabetic ketoacidosis?
Cohort (n=60,607)
Yes
Does comorbid obesity hypoventilation syndrome increase in-hospital mortality and adverse outcomes in patients hospitalized with diabetic ketoacidosis?
Effect estimate: aOR 1.79 (95% CI 1.01-3.15)
p-value: p=<0.044
Comorbid obesity hypoventilation syndrome in patients hospitalized with diabetic ketoacidosis is independently associated with significantly higher in-hospital mortality, acute kidney failure, and need for mechanical ventilation.
May warrant closer monitoring in DKA with comorbid OHS; extends observational associations but leaves causal impact and interventions open.
PURPOSE: The effect of comorbid obesity hypoventilation syndrome (OHS) on hospitalized patients with diabetic ketoacidosis (DKA) has not been studied so far. This study elucidates the outcomes of DKA patients with OHS compared to those without OHS. METHODS: Patients above 18 years of age were included in the study. The National Inpatient Sample (NIS) database of 2017 and 2018 was used and data were extracted using the International Classification of Diseases, Tenth Revision (ICD-10) codes; OHS ICD-10 code being "E66.2" and DKA ICD-10 codes being "E08.1, E09.1, E10.1, E11.1, and E13.1." The comorbid medical conditions were also identified using the ICD-10 codes. Logistic regression analysis was performed to examine the impact of OHS on in-hospital outcomes of DKA patients. RESULTS: OHS was prevalent in 0.61% of the general population, as per the NIS database in the years 2017 and 2018. Primary outcomes of the study were in-hospital mortality, whereas secondary outcomes included acute kidney failure, the requirement for invasive mechanical ventilation, length of stay, and cost of hospitalization. OHS in DKA patients was associated with increased mortality (odds ratio (OR): 4.35 (2.63-7.20), p < 0.00001; adjusted OR (aOR): 1.79 (1.01-3.15), p < 0.044), acute kidney failure (OR: 2.44 (1.79-3.33), p < 0.00001; aOR: 1.43 (1.03-2.00), p < 0.031), invasive mechanical ventilation (OR: 4.17 (2.90-5.98), p < 0.00001; aOR: 1.62 (1.08-2.41), p < 0.017), increased length of stay (10.02 ± 12.42 vs. 4.70 ± 6.31, p < 0.00001), and cost of care (132314 ± 197111.8 vs. 54245.06 ± 98079.89, p < 0.00001). All-cause mortality of patients with DKA and OHS using the Cox proportional hazards ratio was 1.70 (1.02-2.84, p < 0.024) after adjusting for age, race, sex, smoking, obesity, and comorbidities such as heart failure, hypertension, chronic obstructive pulmonary disease, chronic ischemic heart disease, chronic kidney disease, liver disease, and cerebral infarction. CONCLUSION: OHS is an independent risk factor for mortality in DKA, irrespective of the degree of obesity. Further prospective studies are recommended to study the effects of different treatment modalities of OHS such as identification of the need for early non-invasive ventilation or for early invasive mechanical ventilation to improve outcomes in DKA patients.
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Pattipati et al. (2022) conducted a cohort in Diabetic Ketoacidosis (n=60,607). Obesity Hypoventilation Syndrome (OHS) vs. Without Obesity Hypoventilation Syndrome was evaluated on In-hospital mortality (aOR 1.79, 95% CI 1.01-3.15, p=<0.044). Comorbid obesity hypoventilation syndrome in patients hospitalized with diabetic ketoacidosis was associated with increased in-hospital mortality (aOR 1.79) compared to those without the syndrome.