Association of history of heart failure with hospital outcomes of hyperglycemic crises: Analysis from a University hospital and national cohort

Aims: The impact of a history of heart failure (HF) on the outcomes of hospitalization for hyperglycemic crises (diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome) is unknown. We aimed to test the hypothesis that a history of HF has a deleterious impact on the outcomes of hospitalization for hyperglycemic crises. Methods: We used two different datasets: National Inpatient Sample database 2003–2014 and a single University hospital cohort 2007–2017, to identify all adult hospitalizations with a primary diagnosis of hyperglycemic crises. Multivariable regression models were used to analyze the outcomes of in-hospital mortality, length of hospital stay and transfer to nursing home or similar short-term facility between HF and no-HF hospitalizations. Results: Of the 1, 570,726 hyperglycemic crises related hospitalizations, a history of HF was present in 57, 520 (3.6%) hospitalizations. After multivariable risk-adjustment, HF group had a higher observed in-hospital mortality [0.4% vs. 0.2%; adjusted odds ratio (AOR) = 1.7, 95% CI 1.4 to 2.0, P <.001] and transfer to nursing home or similar short-term facility (3.9 vs. 2.8%, AOR = 1.4, 95% CI 1.3 to 1.5, P <.001) compared with no-HF group. Mean length of hospital stay [6.5 vs. 3.5 days; P <.001] was also higher for HF group than no-HF group. Data from the smaller University hospital cohort showed similar findings. Conclusions: Patients with a history of HF may be an under-recognized high-risk group among patients hospitalized for hyperglycemic crisis. Additional studies are warranted to clarify risk elements and optimize the inpatient care of individuals with hyperglycemic crises.