Diabetic ketoacidosis and hyperglycemic hyperosmolar state are associated with higher in-hospital mortality and morbidity in diabetes patients hospitalized with ST-elevation myocardial infarction, but not within 30 days of readmission.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Diabetic Ketoacidosis*/mortality ; Diabetic Ketoacidosis*/complications ; Diabetic Ketoacidosis*/epidemiology ; Patient Readmission*/statistics & numerical data ; ST Elevation Myocardial Infarction*/mortality ; ST Elevation Myocardial Infarction*/complications ; ST Elevation Myocardial Infarction*/epidemiology ; Hospital Mortality* ; Hyperglycemic Hyperosmolar Nonketotic Coma*/complications ; Hyperglycemic Hyperosmolar Nonketotic Coma*/mortality ; Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/mortality; Humans ; Male ; Female ; Middle Aged ; Aged ; Shock, Cardiogenic/mortality ; Shock, Cardiogenic/epidemiology ; Shock, Cardiogenic/complications ; Shock, Cardiogenic/etiology ; Acute Kidney Injury/mortality ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/etiology ; Risk Factors ; Hospitalization ; Aged, 80 and over

Competing Interests: The authors have declared that no competing interests exist.
Background: While the cardiovascular risk of hyperglycemia has been thoroughly elucidated in patients with type 2 diabetes (T2DM) hospitalized for myocardial infarction, the evidence surrounding acute severe hyperglycemia is less well-established. Our study aimed to explore the impact of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS), both severe hyperglycemic conditions, on cardiovascular outcomes in patients with T2D admitted for ST-elevation myocardial infarction (STEMI).
Methods: We used the National Readmission Database (2016-2019) to extract patients with T2DM and STEMI at baseline. Subsequently, we selected cases of DKA and HHS. The primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital acute renal failure, cardiogenic shock, and 30-day readmission and mortality.
Results: The presence of DKA increased the adjusted odds of mortality and cardiogenic shock by almost 2-fold (adjusted Odds Ratios aOR = 2.30 [1.70-3.12], 2.055 [1.602-2.637], respectively) and renal failure by nearly 5-fold (aOR = 5.175 [4.090-6.546]). HHS was also associated with higher odds of mortality, acute renal failure, and cardiogenic shock. In 30 days, DKA and HHS increased the risk of readmission (aOR = 1.815 [1.449-2.75], 1.751 [1.376-2.228], respectively). There were no differences in the rates of cardiovascular disease, mortality, or other cardiovascular events between DKA and HHS patients. Within 30 days of readmission, DKA and HHS were associated with higher odds of readmission but not mortality. Cardiovascular disease was the most common etiology of readmission in all patients. The incidence of non-STEMI was the highest in DKA patients, and the incidence of STEMI was the highest in the HHS group.
Conclusion: The presence of diabetic ketoacidosis or hyperglycemic hyperosmolar state is associated with higher odds of mortality, renal failure, cardiogenic shock, and 30-day readmission in STEMI patients with type 2 diabetes, highlighting the need for enhanced clinical management and monitoring of patients experiencing acute hyperglycemia.
(Copyright: © 2025 Almutairi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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Date Created: 20250206 Date Completed: 20250206 Latest Revision: 20250208

20250208

PMC11801527

10.1371/journal.pone.0318774

39913488