e23197 Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are uncommon but high-acuity events that may occur during cancer hospitalizations. National estimates describing their association with inpatient physiologic severity, critical illness, mortality, and resource utilization in oncology hospitalizations remain limited. Methods: A serial cross-sectional, hospitalization-level analysis of the 2018 to 2022 Healthcare Cost and Utilization Project National Inpatient Sample (NIS) was performed using discharge-level survey weighting with hospital clustering and stratification to generate nationally representative estimates. Adult hospitalizations with a principal diagnosis of malignancy were identified using ICD-10-CM codes C00 to C97 and D45 to D47. Hyperglycemic crises were defined using any-diagnosis ICD-10-CM code families for diabetic ketoacidosis (DKA; E10. 1, E11. 1, E13. 1, E08. 1, E09. 1) and hyperosmolar hyperglycemic state (HHS; E10. 0, E11. 0, E13. 0, E08. 0, E09. 0). Outcomes included All Patient Refined Diagnosis Related Group (APR-DRG) severity of illness subclass, with extreme severity defined as APR-DRG level 4, in-hospital mortality, length of stay, hospitalization cost, and ICU proxies including mechanical ventilation and shock. Survey-weighted multivariable models adjusted for demographics, payer, socioeconomic status, admission characteristics, cancer type, and hospital characteristics. Results: Among 961, 848 unweighted cancer hospitalizations representing 4, 809, 239 hospitalizations nationally, DKA occurred in 0. 11%, HHS in 0. 02%, and any hyperglycemic crisis in 0. 12%. Compared to hospitalizations without crisis, hyperglycemic crisis admissions had higher mean APR-DRG severity (3. 52 vs 2. 56), longer length of stay (10. 80 vs 6. 63 days), and higher cost (35, 491 vs 22, 792). Hyperglycemic crises were also associated with higher rates of extreme severity (10. 41% vs 3. 45%), in-hospital mortality (14. 15% vs 4. 37%), mechanical ventilation (9. 99% vs 2. 58%), and shock (7. 24% vs 1. 38%). After adjustment, hyperglycemic crisis remained independently associated with higher inpatient severity (β 0. 72, 95% CI 0. 64 to 0. 80), extreme severity (OR 4. 79, 95% CI 3. 62 to 6. 35), in-hospital mortality (OR 2. 80, 95% CI 2. 35 to 3. 33), mechanical ventilation (OR 3. 50, 95% CI 2. 89 to 4. 25), and shock (OR 4. 65, 95% CI 3. 71 to 5. 83). Conclusions: Although uncommon, hyperglycemic crises create a high-acuity subset of cancer hospitalizations with profound increases in extreme physiologic severity, critical illness, mortality, length of stay, and cost. These findings support hyperglycemic crises as high-priority inpatient risk phenotypes with implications for early recognition, escalation planning, and ICU resource utilization in hospitalized oncology populations.
Everett et al. (Thu,) studied this question.