Aspiration pneumonia in diabetic ketoacidosis: a decade-long analysis of occurrence , associated risk factors and clinical outcomes in 530,700 US hospitalizations.

BACKGROUND: Aspiration pneumonia (AP) is a serious clinical condition among patients with diabetic ketoacidosis (DKA). This study aimed to determine the occurrence and associated risk factors for AP among patients hospitalized with DKA. METHODS: The National Inpatient Sample (2010-2019) was used to identify adults with DKA. Patients were divided into two groups based on the presence of AP. Multivariate logistic regression was performed to identify risk factors associated with AP, adjusting for demographics, Elixhauser comorbidities, and hospital characteristics. RESULTS: Among 530,700 hospitalizations for DKA, 2.0% developed AP. Multivariate analysis revealed that age ≥ 45 years, ≥ 2 comorbidities, large hospital of bed size and urban hospital were associated with higher odds of AP. Specific comorbidities (alcohol abuse, congestive heart failure, coagulopathy, drug abuse, fluid and electrolyte disorders, neurological disorders, paralysis, psychoses, weight loss, and dementia) and complications (gastrointestinal hemorrhage, deep vein thrombosis, sepsis, stroke, blood transfusion) were associated with increased risk of AP. Patients with AP were significantly associated with higher hospital mortality (16.9% vs. 1.8%), longer median hospital stays (9 vs. 3 days), increased median healthcare costs ($97,318 vs. $22,835), and higher need for mechanical ventilation (2.2% vs. 0.1%) (P < 0.001). CONCLUSION: The findings highlight a relatively high occurrence of AP in patients with DKA, strongly associated with various comorbidities. The results emphasize the need for optimized management of high-risk patients to reduce adverse outcomes. Further prospective studies are required to clarify these associations and develop effective prevention strategies.