Delirium in diabetic ketoacidosis: a multicenter observational study of occurrence, associated factors and outcomes from 578,204 hospitalizations.

Abstract

Background: Delirium is a neuropsychiatric syndrome in hospitalized diabetic ketoacidosis (DKA) patients and is associated with poor clinical outcomes. However, multicenter national data on its prevalence and associated factors in this population are lacking.

Methods: Adult patients with DKA were identified from the National Inpatient Sample (2013-2022) and stratified by delirium occurrence. Multivariable logistic regression identified delirium associated factors, including demographics, institutional characteristics, comorbidities, and complications.

Results: In 578,204 DKA-related hospitalizations, delirium was documented in 6,161 hospitalizations (1.1%), increasing from 0.5% in 2013 to 1.4% in 2022. Multivariable analysis demonstrated that patients aged ≥ 45 years, ≥ 2 comorbidities, large hospital and teaching hospital were associated with higher odds of delirium. Comorbidities including alcohol use, congestive heart failure, coagulopathy, depression, liver disease, other neurological disorders, psychoses, weight loss, and dementia correlated with higher delirium odds. Complications such as pulmonary embolism, sepsis, stroke, urinary tract infection, pneumonia, acute myocardial infarction, and acute kidney injury were also associated with delirium. Patients with delirium had prolonged median hospitalization duration (8 vs. 3 days), higher healthcare costs ($82,196 vs. $29,417), and higher mortality (6.4% vs.3.2%) (P < 0.001).

Conclusion: Although delirium occurrence is modest in DKA patients, it is associated with adverse clinical outcome. Healthcare providers should identify high-risk populations and enhance surveillance protocols. Further prospective studies are needed to clarify these associations and develop preventive strategies.