Clinical Characteristics and Outcomes of Diabetic Ketoacidosis among COVID-19 Patients: A Study at Suhar Hospital, Oman

This study's objective is to investigate the prevalence, clinical traits, and outcomes of DKA and COVID-19 patients hospitalized to Suhar Hospital in Oman. Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration. It is a life-threatening complication of diabetes and is usually seen in patients with type-1 diabetes mellitus. Rarely it may also occur in patients with type-2 diabetes mellitus. DKA is a state of a relative or absolute insulin deficiency that is worsened by hyperglycemia, dehydration, and acidosis. In most cases, the trigger is an infection, new-onset diabetes, or lack of compliance with treatment. Diabetic ketoacidosis (DKA) is an acute complication among COVID-19 patients with diabetes mellitus (DM). It is found to be a leading cause of poor prognostic indicators in COVID-19 patients. A retrospective review of DKA patients admitted to Suhar Hospital, Oman, from March 2020 to August 2020. DKA patients will be classified as with or without laboratory- confirmed COVID-19. SPSS, version 22, was used to describe data (median, interquartile range-IQR and percentages) and to test for statistical differences at 5% significance level (chi- square test, Fisher’s exact test and Mann-Whitney U-test). Twenty seven patients were found to fulfill the criteria of DKA. Of them, 13 patients had confirmed COVID representing a prevalence of 1.4%. COVID DKA patients compared to non-COVID were characterized as being males (54% vs. 43%), older (36 vs. 22), longer on hospital stay (5 vs. 2), had T2DM (62% vs. 7%), admitted to ICU (46% vs. 7%) and higher in mortality (31% vs. 0%) as well as clinically presented with a low pH (7 vs. 7.2) and bicarbonate (6.2 vs. 11.1), high serum creatinine (101.0 vs. 84.0) and CRP (34.0 vs. 4.8). Significant factors (p<0.05) found to enhance mortality among COVID DKA patients were COVID pneumonia severity, extensive bilateral radiological infiltrates, ICU admissions, mechanical ventilation, severe metabolic acidosis and higher WBC and Neutrophils. All deceased COVID-19 DKA patients developed complications such as ARDS, renal failure, requiring hemodialysis and septic shock. This study emphasizes the link between COVID-19 and DKA as well as the effects of its 31% death rate and poor prognosis characteristics. This highlights the association of COVID-19 and DKA among T2DM and prolonged hospital stay. Severe COVID pneumonia, severe metabolic acidosis, ICU admissions, mechanical ventilations and high inflammatory markers were poor prognostic factors among COVID-19 patients admitted with DKA.