J Clin Endocrinol Metab. 2021 May 27:dgab372. doi: 10.1210/clinem/dgab372. Online ahead of print.
INTRODUCTION: This study aimed to describe rates and characteristics of non-elective 30-day readmission among adult patients with diabetes mellitus type 1 (T1DM) hospitalized for diabetic ketoacidosis (DKA) and also identify predictors of readmission.
METHODS: The study analyzed the 2018 Nationwide Readmission Database. DKA hospitalizations in patients with T1DM were classified using ICD-10-CM codes. We utilized Chi-square tests to compare baseline characteristics between readmissions and index hospitalizations. Multivariable cox regression was employed to identify independent predictors of readmission. Following this, we developed a 30-day readmission risk scoring system based on independent predictors.
RESULTS: The 30-day all-cause readmission rate for DKA was 19.4%. A majority of patients (64.8%) had 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 vs. 49.6%,p<0.001) compared to the index admission. Readmission following DKA was associated with higher odds of inpatient mortality (0.69 vs. 0.24%, OR: 2.84, 95% CI: 1.99 - 4.06, p<0.001). Independent predictors of 30-day all-cause readmission included female sex, index hospitalizations with Charlson Comorbidity Index (CCI) score of 3 or greater, and being discharged against medical advice (AMA).
CONCLUSION: The readmission rate for DKA in T1DM patients is high, and most patients have DKA as the principal diagnosis on readmission. A CCI equal to or greater than 3, hypertension, female sex, and being discharged AMA were significant predictors of readmission.