Background: SARS CoV-2 has been linked to higher mortality rate among DM patients who present with diabetic ketoacidosis (DKA) and/or hyperosmolar hyperglycemic state (HHS) . The Riverside University Health System Medical Center (RUHS-MC) -DKA Outcomes Group initiated a study to determine outcomes and risk factors before and during the pandemic in patients hospitalized at RUHS-MC with DKA and/or HHS.

Methods: This was a retrospective cohort study reviewing medical records of non-pregnant adults age 18 or older admitted to the RUHS-MC for DKA and/or HHS from 03/2020 to 02/2021 (“pandemic”) compared to 3 years before the pandemic (“pre-pandemic”) . Descriptive statistics were used to determine the clinical characteristics. Logistic regression was used to assess the impact of the parameters on the death rate.

Results: The mortality rate of DKA and/or HHS was 9% (30/335) during pandemic vs. 1.8% (15/855) during pre-pandemic. Six out of 30 patients died without COVID-19 infection, consistent with the pre-pandemic mortality rate. Pre-existing myocardial infarction and lower beta-hydroxybutyrate level were associated with increased mortality (Table 1) .

Discussion: At our institution, the mortality rate of DKA and/or HHS during pandemic was significantly higher, specifically associated with COVID-19 infection. Our study suggests concomitant COVID-19 is a highly lethal and independent factor in patients that develop DKA. The gender disparity in mortality is unexplained and requires additional studies.


A. J. Yang: None. M. A. Firek: n/a. I. Munir: None. A. Tran: None. A. Firek: None.

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