title: Predictors of Recurrent Hospital Admission for Patients Presenting With Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are two serious, preventable complications of diabetes mellitus. Analysis of variables associated with recurrent DKA and HHS admission has the potential to improve patient outcomes by identifying possible areas for intervention. The aim of this study was to evaluate potential predictors of recurrent DKA or HHS admission.
  
  
  METHODS
  This was a retrospective case-control study of 367 patients presenting during a 5-year period with DKA or HHS at a US tertiary academic medical center. Six potential readmission risk factors identified via literature review were coded as "1" if present and "0" if absent. Readmission odds ratios (ORs) for each risk factor and for the combined score of significant risk factors were calculated by logistic regression.
  
  
  RESULTS
  Readmission odds were significantly increased for patients with age < 35, history of depression or substance/alcohol abuse, and self-pay/publicly funded insurance. HbA1C > 10.6% on admission and ethnic minority status did not significantly increase readmission odds, with inadequate study power for these variables. A total "ABCD" score, based on Age (< 35 years), Behavioral health (depression), insurance Coverage (self-pay/publicly funded insurance), and Drug/alcohol abuse, also had a significant effect on readmission odds.
  
  
  CONCLUSIONS
  Consideration of individual risk factors and the use of a scoring system based on objective predictors of recurrent DKA and HHS admission could be of value in helping identify patients with high readmission risk, allowing interventions to be targeted most effectively to reduce readmission rates, associated morbidity, and mortality.
authors.affiliation: Department of Psychiatry, Maine Medical Center, 22 Bramhall St., Portland, ME 04102, USA.
authors.forename: Annabel L
authors.initials: AL
authors.lastname: Bradford
authors.affiliation: Department of Dermatology, Saint Louis University, 1755 South Grand Boulevard, St. Louis, MO 63104, USA.
authors.forename: Courtney Champagne
authors.initials: CC
authors.lastname: Crider
authors.affiliation: University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA.
authors.forename: Xizheng
authors.initials: X
authors.lastname: Xu
authors.affiliation: University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA.
authors.forename: Syed Hasan
authors.initials: SH
authors.lastname: Naqvi
keywords: Diabetes mellitus; Health care quality; Hospital admission