Acute Metabolic Emergencies in Diabetes and COVID-19: a systematic review and meta-analysis of case reports
COVID-19 is associated with DKA (Diabetic Ketoacidosis), HHS (Hyperglycaemic Hyperosmolar State) and EDKA (Euglycaemic DKA). High mortality has been observed in COVID-19-related diabetic ketoacidosis; however, evidence is scarce. Patients and Methods: A systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January to December 2020 to identify all case reports describing DKA, HHS, and EDKA, in COVID-19 patients. The Joanna Briggs Institute critical
... itute critical appraisal checklist for case reports was used for quality assessment. Univariate and multivariate analysis assessed correlations of study origin, combined DKA/HHS, age, BMI, HbA1c, administered antidiabetics, comorbidities, symptoms onset, disease status, CRP, ferritin, d-dimers, glucose, osmolarity, pH, bicarbonates, ketones, lactates, β-hydroxybutyric acid, anion gap, and acute kidney injury (AKI) with outcome. Results: From 312 identified publications, 41 including 71 cases analyzed qualitatively and quantitatively. Multivariate analysis demonstrated that COVID-19 disease status 4 (P<0.001), AKI (P<0.001), pH ≤7.12 (P=0.032), and osmolarity ≥324 (P=0.034), are all independently correlated with death. COVID-19 Disease Status 4 (P=3x10-8), combined DKA/HHS (P=0.021), and AKI (P=0.037) are independently correlated with death. Conclusion: COVID-19 intertwines with acute metabolic emergencies in diabetes leading to increased mortality; key determinants are critical COVID-19 illness, co-presence of ketoacidosis and hyperosmosis and AKI.