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Early readmissions of spontaneous bacterial peritonitis (SBP) are often associated with poor outcomes. We compared characteristics and outcomes for index and 30-day readmissions of SBP in the USA.We analyzed the Nationwide Readmissions Database for 2018 to identify all adult (≥ 18 years) 30-day readmissions of SBP in the USA. Hospitalization characteristics and outcomes for index and 30-day readmissions of SBP were compared. Independent predictors of 30-day readmissions were also identified.In 2018, of the 5,797 index admissions for SBP, 30% (1726) were readmitted within 30 day. At the time of readmission, the most common admitting diagnosis was alcoholic cirrhosis of the liver with ascites (11.8%) followed by sepsis due to an unspecified organism (9.2%). SBP as an admitting diagnosis was identified for only 8.3% of these 30-day readmissions. Compared with index admissions, 30-day readmissions of SBP had a lower mean age (56.1 vs 58.6 years, P 0.001) without a statistically significant difference for gender. Furthermore, 30-day readmissions of SBP were associated with significantly higher odds of inpatient mortality (10% vs 4.9%, OR: 2.15, 95% CI: 1.66-2.79, P 0.001), and mean total hospital charge ($85,031 vs $56,000, mean difference: 29,032, 95% CI: 12,867-45,197, P 0.001) compared with index admissions. The presence of chronic pulmonary disease, liver failure, inpatient dialysis, and discharge against medical advice were identified as independent predictors for increased 30-day readmissions of SBP.The 30-day readmission rate of SBP was 30% and these readmissions were associated with higher odds of inpatient mortality compared with index admissions.

Alcohol use disorder, high-risk drinking, and emergency visits for acute and chronic complications of alcohol use have been increasing in the USA recently. Approximately half of patients with alcohol use disorder experience alcohol withdrawal when they reduce or stop drinking. Though alcohol withdrawal is usually mild, 20% of patients experience more severe manifestations such as hallucinations, seizures, and delirium. In this study, we utilized the Nationwide Inpatient Sample to examine the trends of alcohol withdrawal delirium (AWD) in the period 2010 - 2019.This was a retrospective longitudinal trends study involving hospitalizations with AWD in the USA from 2010 to 2019. We searched the databases for hospitalizations using the International Classification of Diseases (ICD) codes (291.0 and F10231). We involved all hospitalizations complicated by AWD and hospitalizations with AWD as the principal diagnosis for admission. We excluded hospitalizations involving patients under the age of 18. We calculated the crude admission rate and the incidence of AWD per million adult hospitalizations during each calendar year. In addition, we analyzed trends of inpatient mortality, length of stay (LOS), and total hospital charges (THC).The incidence of AWD per million hospitalizations increased from 2,671.8 in 2010 to 3,405.6 in 2019, with an annual percentage change (APC) of 3.1% (P0.001). Similarly, AWD admission rate per million hospitalizations increased from 1,030.3 in 2010 to 1,556.0 in 2019, with an average APC of 5.0% (P0.001). There were statistically significant trends of increasing inpatient mortality, THC, and LOS over the studied period. In general, female gender, younger age, and Black race were associated with better clinical outcomes.Our study showed an increase in the incidence and admission rates of AWD. Mortality, LOS, and THC increased over the studied period. Younger age, female gender, and Black race were associated with better clinical outcomes.

Acute pancreatitis is a common inflammatory condition that involves the pancreas. Gallstones and alcohol are the most common etiologies in the USA. Cholecystectomy is the cornerstone procedure in the management of biliary acute pancreatitis (BAP). In this study, we examined the causes and predictors of readmissions following BAP based on the procedure performed.Using the Nationwide Readmissions Database (NRD) and the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD10-CM/PCS), we retrospectively studied BAP hospitalizations (2016 - 2018). The first hospitalization within the year was marked as index hospitalization. Index hospitalizations were categorized based on whether an endoscopic retrograde cholangiopancreatography (ERCP) and/or a cholecystectomy was performed into no procedure group, ERCP group, cholecystectomy group, and both procedures group. We subsequently identified readmissions within 30 days. Using this categorization, we studied reasons, rates, and predictors of readmissions.A total of 127,318 index hospitalizations were included. The cholecystectomy group constituted the largest share of this cohort (43.5%). Using the no procedure group as a reference, analysis of the outcomes showed that the cholecystectomy group had the lowest inpatient mortality (adjusted odds ratio (aOR): 0.18, P0.001), while both procedures group had the highest total hospital charges (adjusted mean difference (aMD): 42,249, P0.001). Acute pancreatitis without necrosis or infection was the most frequent principal diagnosis for readmission (18.7%). Analysis of readmission predictors showed that both procedures group had the lowest risk for readmission (adjusted hazard ratio (aHR): 0.40, P0.001). Females were less likely to be readmitted compared to males (aHR: 0.82, P0.001) and elderly were less likely to be readmitted compared to young adults (aHR: 0.82, P0.001). Patients discharged against medical advice were more likely to be readmitted (aHR: 1.76, P0.001).Undergoing both ERCP and cholecystectomy for BAP resulted in significantly higher hospital charges with no additional mortality benefit. However, it decreased the readmission risk significantly. Acute pancreatitis without necrosis or infection was the most frequent reason for readmissions.

Adrenal insufficiency (AI) is a severe disease that is difficult to manage in both inpatient and outpatient settings. This study describes trends, inpatient outcomes, and the disease burden of hospitalizations for patients with AI. Data are included on hospitalizations with a principal discharge diagnosis of AI using ICD codes from the National Inpatient Sample for the years 2008, 2010, 2012, 2014, 2016, and 2018. Patients 3. There was a significant downward trend in the length of stay from 2008 to 2018 (P-trend = 0.005). However, there was no statistically significant trend for mortality or mean total hospital charges during hospitalizations (P-trend = 0.050 and 0.076, respectively). In conclusion, AI hospitalizations significantly increased over the 10 years with an overall decrease in length of stay.

With the evolution of pulmonary embolism (PE) management, the outcomes of PE-related complications and the need for readmission have not been well studied. The aim of this study is to see the trend in readmissions in patients with PE from 2010 to 2018. We used the National Readmission Database from 2010 to 2018 to identify hospitalized patients with a principal diagnosis of acute PE. We then identified the total number of readmissions for acute PE from 2010 to 2018. These were further stratified based on readmission within 30 days and readmission within 90 days. A multivariate Cox regression model was used to adjust for confounding factors. The 30-day all-cause readmission after principal admission for PE decreased from 11.2% to 9.7% from 2010 to 2014 but increased to 11.8% in 2018 (p0.001). A similar trend was seen in 90-day readmission. Risk-adjusted readmission specific for PE showed a decrease from 1.2% to 1% (p = 0.004) in the 30-day cohort and from 1.4% to 1.2% (p = 0.006) in the 90-day cohort from 2010 to 2018. When adjusted to age and gender, an increase in the proportion of readmissions with intracranial bleeding was seen among both the 30-day (0.7% in 2010 to 1.2% in 2018, adjusted odds ratio [aOR] 1.06, p = 0.006) and 90-day (0.7% in 2010 to 1.2% in 2018, aOR 1.06, p-trend = 0.003) cohorts. Similarly, an increasing trend of readmissions for upper gastrointestinal bleed was seen among both 30-day (0.9% vs 4.3%, aOR 1.26, p-trend0.001) and 90-day (0.7% vs 3.8%, aOR 1.27, p-trend0.001) readmissions. Our study suggests that there is a statistically significant decrease in PE-specific readmission from 2010 to 2018 but a variable trend in all-cause readmissions. We also report an increase in bleeding during readmissions, including intracranial hemorrhage and upper gastrointestinal bleed. In conclusion, these findings warrant further studies to elucidate the mechanism for decreasing PE-specific readmission and possible causes for the increase in all-cause readmissions.

Alcohol consumption is associated with numerous hepatic manifestations, including alcoholic fatty liver disease, alcoholic hepatitis (AH), and liver cirrhosis. AH is a common and serious complication of alcohol use. Gastrointestinal bleeding (GIB) remains one of the most common causes of death in these patients. In this article, we studied the trends of GIB after AH.This was a retrospective interrupted trend study. We analyzed the 2010, 2012, 2014, 2016, and 2018 Nationwide Readmission Databases. The first AH hospitalization in the year was marked as index hospitalization. We identified subsequent hospitalizations with GIB within 30 days and marked them as readmissions. A multivariate regression analysis was used to calculate the risk-adjusted odds of trends for GIB readmissions, including esophageal varices bleeding (EVB), upper GIB, lower GIB, and all GIB.The volume of index hospitalizations increased from 10,248 in 2010 to 16,479 in 2018. Similarly, all readmissions increased from 1,838 in 2010 to 3,908 in 2018. Of all readmissions, EVB increased from 3.9% in 2010 to 5.9% in 2018 (odds ratio (OR) trend 1.10; P0.001). Readmissions for upper GIB increased from 2.4% in 2010 to 7.8% in 2018 (OR trend 1.22; P0.001). On the other hand, lower GIB readmissions decreased from 7.2% in 2010 to 4.7% in 2018 (OR trend 0.95; P = 0.015). There was no statistically significant trend for all GIB readmissions (OR trend 1; P = 0.915).Further studies are needed to evaluate the patterns of lower GIB in patients with liver disease and the recent trends of corticosteroids use in AH patients.

Objective This study aims to compare the outcomes of patients primarily admitted for acute coronary syndrome (ACS) with and without systemic sclerosis (SSc). The primary outcome was odds of inpatient mortality. Hospital length of stay, total hospital charges, rates of cardiovascular procedures, and treatments were secondary outcomes of interest. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalizations for adult patients with ACS (ST-segment elevation myocardial infarction [STEMI], non-ST-segment elevation myocardial infarction [NSTEMI], and unstable angina) as principal diagnosis with and without SSc as secondary diagnosis using International Classification of Diseases, Tenth Revision codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results There were more than 71 million discharges included in the combined 2016 and 2017 NIS database. There were 1,319,464 hospitalizations for adult patients with a principal International Classification of Diseases, Tenth Revision code for ACS. There were 1155 (0.09%) of these hospitalizations that had SSc. The adjusted odds ratios for inpatient mortality for ACS, STEMI, and NSTEMI hospitalizations with coexisting SSc compared with those without SSc were 2.02 (95% confidence interval [CI], 1.19-3.43; p = 0.009), 2.47 (95% CI, 1.05-5.79; p = 0.038), and 2.19 (95% CI, 1.14-4.23; p = 0.019), respectively. Conclusions Acute coronary syndrome hospitalizations with SSc have increased inpatient mortality compared with those without SSc. ST-segment elevation myocardial infarction and NSTEMI hospitalizations with SSc have increased inpatient mortality compared with STEMI and NSTEMI hospitalizations without SSc, respectively. Acute coronary syndrome hospitalizations with SSc have similar hospital length of stay, total hospital charges, rates of revascularization strategies (percutaneous coronary intervention, coronary artery bypass surgery, and thrombolytics), and other interventions (such as percutaneous external assist device and intra-aortic balloon pump) compared with those without SSc.

Purpose The aim of this study was to compare the outcomes of patients primarily admitted for atrial fibrillation (AFib) with and without a secondary diagnosis of systemic sclerosis (SSc). The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, and electrical cardioversion were secondary outcomes of interest. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for adult hospitalizations with AFib as principal diagnosis with and without SSc as secondary diagnosis using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Of 821,630 AFib hospitalizations, 750 (0.09%) had SSc. The adjusted odds ratio for inpatient mortality for AFib with coexisting SSc compared with without coexisting SSc was 3.3 (95% confidence interval, 1.27-8.52; p = 0.014). Atrial fibrillation with coexisting SSc hospitalizations had similar LOS (4.2 vs 3.4 days; p = 0.767), mean total hospital charges ($40,809 vs $39,158; p = 0.266), odds of undergoing ablation (2.7% vs 4.2%; p = 0.461), and electrical cardioversion (12.0% vs 17.5%; p = 0.316) compared with without coexisting SSc. Conclusions Patients admitted primarily for AFib with a secondary diagnosis of SSc have more than 3 times the odds of inpatient death compared with those without coexisting SSc. Hospital LOS, total hospital charges, likelihood of undergoing ablation, and electrical cardioversion were similar in both groups.

OBJECTIVES The aims of this study were to compare the outcomes of patients primarily admitted for ischemic stroke with and without a secondary diagnosis of RA. METHODS Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS was searched for hospitalizations for adult patients with ischemic stroke as principal diagnosis with and without RA as secondary diagnosis using International Classification of Diseases, 10th Revision codes. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of receiving tissue plasminogen activator, and mechanical thrombectomy were secondary outcomes of interest. Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders. RESULTS There were more than 71 million discharges included in the combined 2016 and 2017 NIS database. Of 525,570 patients with ischemic stroke, 8670 (1.7%) had RA. Hospitalizations for ischemic stroke with RA had less inpatient mortality (4.7% vs. 5.5%; adjusted odds ratio, 0.66; 95% confidence interval, 0.52-0.85; p = 0.001), shorter LOS (5.1 vs 5.7 days, p < 0.0001), lower mean total hospital charges ($61,626 vs. $70,345, p < 0.0001), and less odds of undergoing mechanical thrombectomy (3.9% vs. 5.1%; adjusted odds ratio, 0.55; 95% confidence interval, 0.42-0.72; p < 0.0001) compared with those without RA. CONCLUSIONS Hospitalizations for ischemic stroke with RA had less inpatient mortality, shorter LOS, lower total hospital charges, and less likelihood of undergoing mechanical thrombectomy compared with those without RA. However, the odds of receiving tissue plasminogen activator were similar between both groups. Further studies to understand its mechanism would be helpful.

Ventilator-associated pneumonia (VAP) is a major cause of healthcare-associated mortality and morbidity in critically ill patients who are mechanically ventilated. The purpose of this study was to describe the various primary discharge diagnoses of hospitalizations with VAP, to identify their demographic characteristics, and to identify risk factors for mortality in hospitalizations with VAP. Hospitalizations with a diagnosis of VAP with mechanical ventilation for over 24 hours were selected from the National Inpatient Sample in 2016 and 2017. In total, 33,140 hospitalizations with VAP were analyzed. The leading principal discharge diagnoses for hospitalizations leading to VAP were sepsis due to an unspecified organism (16.92%), respiratory failure (8.09%), and VAP (6.38%). Mortality among hospitalizations with VAP was 20.9%. Independent risk factors for mortality in hospitalizations with VAP were uninsured status (adjusted odds ratio [aOR] 2.13, 95% confidence interval [CI] 1.49–3.06, P

Liver cirrhosis is a major burden on the health care system. Alcohol is one of the most common etiologies of cirrhosis. The aim of our article is to examine the trends of alcoholic liver cirrhosis (ALC) hospitalizations over the past two decades.This was a retrospective longitudinal study. Using the International Classification of Diseases, Ninth Revision, Clinical Modification/Procedure Coding System (ICD-9-CM/PCS) and the ICD-10-CM/PCS, the Nationwide Inpatient Sample (NIS) database was analyzed. We included 1998, 2003, 2008, 2013, and 2018 NIS databases. Using multivariate regression analysis, we examined trends of ALC hospitalizations including inpatient mortality, mean length of stay (LOS), and mean total hospital charges (THCs).We included 261,420 hospitalizations with ALC as the primary diagnosis for admission. There was a trend toward increasing hospitalizations over that period; they increased from 46,186 in 1998 to 69,970 in 2018 (P0.001). Moreover, there was a 2.1-fold increase in the mean THC in 2018 compared to 1998 (P0.001). On the other hand, inpatient mortality decreased from 12.8% in 1998 to 4.7% in 2018 (P0.001), and a trend of decreasing mean LOS was observed. The mean LOS decreased from 7.0 days in 1998 to 5.9 days in 2018 (P0.001).Over the last two decades, there was a trend of increasing hospitalizations and THC. However, we noticed a trend toward decreasing inpatient mortality and LOS over that period, which might reflect in part an improvement in the medical care provided for these patients.

Objective This study was designed to assess the epidemiological trends and outcomes associated with Hepatorenal Syndrome (HRS). Methods This retrospective interrupted trend study used the Nationwide Inpatient Sample (NIS) database for the years 2008, 2012, 2014, 20z16 and 2018 to identify adult (≥18 years) hospitalizations with a primary diagnosis of HRS. We determined epidemiological characteristics and trends for HRS hospitalizations. Additionally, we also calculated the inpatient mortality, mean length of stay (LOS) and mean total hospital charge (THC) using a multivariate regression trend analysis. Results There was an increase in the total number of HRS hospitalizations from 22,864 in 2008 to 42,985 in 2018 with a trend towards increasing hospitalizations (p-trend

Background and objective Database research has shaped policies, identified trends, and informed healthcare guidelines for numerous disease conditions. However, despite their abundant uses and vast potential, administrative databases have several limitations. Adjusting outcomes for comorbidities is often needed during database analysis as a means of overcoming non-randomization. We sought to obtain a model for comorbidity adjustment based on Clinical Classifications Software Refined (CCSR) variables and compare this with current models. Our aim was to provide a simplified, adaptable, and accurate measure for comorbidities in the Agency for Healthcare Research and Quality (AHRQ) databases, in order to strengthen the validity of outcomes. Methods The Nationwide Inpatient Sample (NIS) database for 2018 was the data source. We obtained the mortality rate among all included hospitalizations in the dataset. A model based on CCSR categories was mapped from disease groups in Sundararajan's adaptation of the modified Deyo’s Charlson Comorbidity Index (CCI). We employed logistic regression analysis to obtain the final model using CCSR variables as binary variables. We tested the final model on the 10 most common reasons for hospitalizations. Results The model had a higher area under the curve (AUC) compared to the three modalities of the CCI studied in all the categories. Also, the model had a higher AUC compared to the Elixhauser model in 8/10 categories. However, the model did not have a higher AUC compared to a model made from stepwise backward regression analysis of the original 21-variable model. Conclusion We developed a 15-CCSR-variable model that showed good discrimination for inpatient mortality compared to prior models.

The prevalence of Crohn's disease (CD) and ulcerative colitis (UC) is on the rise worldwide. This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.To identify trends and adverse outcomes for 30 d readmissions for CD and UC.This was a retrospective, interrupted trends study involving all adult (≥ 18 years) 30 d readmissions of CD and UC from the National Readmission Database (NRD) between 2008 and 2018. Patients18 years, elective, and traumatic hospitalizations were excluded from this study. We identified hospitalization characteristics and readmission rates for each calendar year. Trends of inpatient mortality, mean length of hospital stay (LOS) and mean total hospital cost (THC) were calculated using a multivariate logistic trend analysis adjusting for age, gender, insurance status, comorbidity burden and hospital factors. Furthermore, trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations. StataTotal number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC. We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9% in 2010 to 17.6% in 2018 (There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.

IntroductionAcute pulmonary embolism (PE) is known to be associated with significant short-term and long-term complications. However, with the evolution of PE management, the outcomes of PE-related complications and the need for readmission have not been well studied. The aim of this study is to see the trend in readmissions in PE patients from the years 2010 to 2018.MethodsWe utilized the National Readmission Database from 2010 to 2018 to identify hospitalized patients with a principal diagnosis of acute pulmonary embolism. Identified the total number of readmissions for acute PE from 2010 to 2018. A multivariate cox regression model was used to identify independent predictors of readmission.ResultsThe number of patients with 30-day readmissions has gradually increased from 14,508 in 2010 to 19,703 in 2018. The proportion of females admitted was higher than males in all years. The 30-day all-cause readmission after principal admission for PE decreased from 11.2% to 9.7% from 2010 to 2014 but increased to 11.8% in 2018 (pConclusionOur study suggests that there is a statistically significant decrease in PE-specific readmission from 2010 to 2018, but an increase in all-cause readmissions. We also report an increase in non-major bleeding during readmissions, including ICH and UGI bleed. These findings warrant further studies to elucidate the mechanism for decreasing PE-specific readmission but possible causes for the increase in all-cause readmission in the hope of optimizing management and continuing improving outcomes.

Introduction: Acute pulmonary embolism(PE) is known to be associated with significant short term and long term complications. However with evolution of PE management, the outcomes of PE related complications and need for readmission has not been well studied. Our aim of this study is to see the trend in readmissions in PE patients from the years 2010 to 2018. Methods: We utilized the National Readmission Database from 2010 to 2018 to identify hospitalized patients with a principal diagnosis of acute pulmonary embolism. Identified the total number of readmissions for acute PE from 2010 to 2018. Multivariate cox regression model was used to identify independent predictors of readmission. Results: The number of patients with 30-day readmissions have gradually increased from 14,508 in 2010 to 19,703 in 2018. The proportion of females admitted was higher than males in all years.The 30-day all cause readmission after principal admission for PE decreased from 11.2% to 9.7% from 2010 to 2014 but increased to 11.8% in 2018 (p Conclusion: Our study suggests that there is a statistically significant decrease in PE specific readmission, with a decrease followed by an increase in all-cause admission after a PE. There is also no significant difference in mortality and length of stay. These findings warrant further studies to elucidate the mechanism for decrease PE-specific readmission but possible causes for the increase in all-cause readmission in the hope of optimizing management and continuing improving outcomes.

Left ventricular noncompaction (LVNC) is a relatively rare myocardial disorder which is characterized by trabeculations and deep intertrabecular recesses within the left ventricle. LVNC is often asymptomatic but may present with heart failure, arrhythmias, or systemic thromboembolism. Uncommonly, patients with LVNC can present with syncope. In this article, we report one such presentation of this rare medical condition.

Background Alcoholic hepatitis (AH) readmissions are commonly secondary to relapse to alcohol use after discharge from the hospital. Methods This retrospective interrupted trend study analyzed the National Readmissions Database (NRD) from 2010 to 2018 to identify 30-day readmissions of AH using the International Classification of Diseases (ICD)-9 and ICD-10 codes (571.1 and K70.1). Individuals < 18 years, elective and traumatic readmissions were excluded. The biodemographic characteristics and hospitalization trends were highlighted over an 8-year time frame. A multivariate regression analysis was used to calculate the risk-adjusted odds of trends for all-cause 30-day readmissions, AH-specific readmissions, inpatient mortality, mean length of stay (LOS), and mean total hospital charge (THC) after adjusting for age, gender, grouped Charlson Comorbidity Index (CCI), type of insurance, mean household income, and hospital characteristics. P-values ≤ 0.05 were considered statistically significant. Results We noted an increasing trend for total 30-day readmissions of AH from 1,839 in 2010 to 3,784 in 2018 (P-trend < 0.001). Males made up a majority of the population; however, gender distribution was not statistically significant. Additionally, 30-day AH readmissions had an increasing comorbidity burden with time. The 30-day all-cause readmission rate increased from 18.8% in 2010 to 24.4% in 2018 and AH-specific readmission rate from 2.9% in 2010 to 3.9% in 2018 without a statistically significant trend. However, we noted a declining risk-adjusted trend of inpatient mortality for 30-day readmissions of AH from 8.7% in 2010 to 7.4% in 2018 (P-trend = 0.022). Furthermore, the total LOS attributable to 30-day readmissions of AH increased by 132.5% from 11,275 days in 2010 to 26,220 days in 2018 and the attributable THC increased by 160.9% to over $67 million in 2018. Conclusions For 30-day AH readmissions, inpatient mortality declined to 7.4% in 2018, while the total number of hospitalizations, LOS and THC increased from 2010 to 2018.

Introduction Hyperglycemic emergencies, including diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS), are common reasons for hospitalization among adults with diabetes. Household income is a known determinant of health and impacts access to medications and health services. Outpatient services and medications impact readmission rates as medication nonadherence and inadequate follow-up are common underlying precipitants of DKA and HHS. This study outlined the trends in readmissions following initial hospitalization for hyperglycemic emergencies. Methods This was a longitudinal trend analysis of the National Readmission Database (NRD), which is the largest readmission database in the US. The study period was from 2010 to 2018, and involved adults with DKA and HHS as the principal discharge diagnosis. We excluded elective and December admissions. Using the unique visit linkage variable within the NRD, we estimated the 30-day all-cause readmission rate (30ACR) stratified by the median household income for the patient's zip code quartile (MHOI). Outcomes included comparing trends in 30ACR in DKA and HHS between the low-income quartile (LIQ) and high-income quartile (HIQ) as well as trends in 30-day DKA and HHS specific readmission rates between the LIQ and HIQ. We estimated the estimated annual percent change (APC) via logistic trend regression adjusted for age categories, sex, and MHOI. Results From 2010 to 2018, there was a trend towards increasing readmission rates overall. Among DKA hospitalizations, patients in the LIQ had a higher 30ACR compared to the HIQ (17.1% vs 12.3% in 2010 and 21.7% vs 15.3% in 2018). The LIQ patients also had a higher DKA-specific readmission rate over the period (7.2% vs 5.1% in 2010 and 7.6% vs 10.4% in 2018). The adjusted APC for DKA 30ACR was 1.6%, with the overall odds of readmission higher in the LIQ (adjusted odds ratio [aOR]: 1.50, 95% CI: 1.42 - 1.58, p Conclusion There seem to be rising readmission rates following hyperglycemic emergency hospitalizations with significant disparity based on median household income. This difference is was higher DKA. Though the study design limits the elaboration on specific income-related factors that are at play, these findings establish the need for further exploring the barriers that predispose patients to readmissions to decrease healthcare utilization costs. Presentation: Tuesday, June 14, 2022 10:45 a.m. - 11:00 a.m.

Introduction Major depressive disorder (MDD) is highly prevalent inpatientswith Diabetes type 1 (DM1),its impact on DKA incidence and outcomes is not well documented. Our goal with this study isto outline the impact of MDD on patients admitted with DKA and compare outcomes with those without comorbid MDD. Methods This was a retrospective study involving adult hospitalizations for DKA in patients with T1D in the USA. We extracted data from the Nationwide Readmissions Database (NRD) of 2018. The study involved hospitalizations with DKA as the principal diagnosis in patients with T1D using ICD-10 diagnostic codes (E101). We deemed this as the reason for the index admission. This cohort was grouped based on the presence of a secondary diagnostic code of depressive disorder. Using unique hospitalization identifiers available in the NRD, we identified index hospitalizations, and one subsequent hospitalization within 30 days was tagged as readmission. Outcomes included comparing the 30-day all cause readmission of DKA in patients with and without depressive disorders. We also compared DKA specific readmission in both groups. We compared mortality, mean length of hospital stay (LOS), total hospital charges (THC), and cost of hospitalization (COH) between the groups. We also assessed whether comorbid depressive disorder is an independent predictor for readmission in hospitalizations for DKA. Results Of 94,747 patients admitted with DKA, 17.93% had a diagnosis of major depression disorder (MDD). Mean length of hospitalization during initial admission was longer in patients with MDD by 0.5 days in comparison to those without (3.35 vs. 2.84 days; p Conclusion This study showed that patients with MDD admitted for DKA had greater healthcare burden and worse patient outcomes in terms of readmission risk, in-hospital mortality rate and length of hospital stay. Exact factors behind this association are not completely clear and still need to be investigated. An area for future research is assessing if successful MDD diagnosis and management could decrease DKA incidence and improve healthcare and patient burden. Presentation: No date and time listed

Introduction The syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) is one of the most significant causes of potentially life-threatening hyponatremia. Hypertriglyceridemia (HTG), on the other hand, is one of the few disorders that spuriously reduce sodium levels and should be ruled out in the evaluation of patients with hyponatremia. Very scant literature exists on the coexistence of both conditions, and even less literature compares outcomes in patients with concomitant SIADH and HTG. Method We extracted data from the US Nationwide Inpatient Sample (NIS) for 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for SIADH using the ICD-10-CM code (E22.2). Hospitalizations of patients less than 18 years were excluded. We then sub-divided the cohort based on the presence/absence of a secondary diagnosis of HTG. Outcomes compared include inpatient mortality rates, mean length of hospital stay (LOS), mean hospitalization cost (THC), and rates of comorbid septic shock, acute myocardial infarction (AMI), acute respiratory failure (ARF), acute renal failure (AKI), and acute pulmonary edema (PE) between the subgroups. An adjustment was made for age, sex, race, primary payer, median household income by zip code, Charlson Comorbidity Index (CCI), hospital location, bed-size, and teaching status using multivariate regression analysis. Statistical significance was set at a p-value < 0.05. Results There were 39,110 hospitalizations involving patients with SIADH as the reason for the admission in 2019. Of these hospitalizations, 41.8% had comorbid HTG. A higher proportion of SIADH hospitalizations involved females, with no significant difference between both cohorts (61 vs 62.7%, p=0.119). Patients with HTG had a higher mean age (75.8±11.1 vs 70.4±14.4 years, p2, and a higher proportion of ethnic minorities compared to patients without HTG. Hospitalizations for SIADH with comorbid HTG were associated with lower adjusted odds ratio (aOR) for mortality (0.7 vs 1.4% in patients with HTG, aOR: 0.42, p Conclusions Interestingly, comorbid HTG lowered odds of mortality, LOS, and THC amongst patients hospitalized for SIADH. More studies should be carried out to investigate this rather paradoxical relationship with a view to defining a better understanding and devising more therapeutic strategies for both conditions. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:48 p.m. - 12:53 p.m.

Introduction Protein-energy malnutrition (PEM) is a leading cause of morbidity and mortality, particularly in developing countries. Via multiple mechanisms, there is an association between PEM and hyponatremia, but not much is known about concomitant PEM and the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) or the effect of PEM on the outcomes of patients admitted with SIADH. Methods We extracted data from the US Nationwide Inpatient Sample (NIS) for 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for SIADH using the ICD-10-CM code (E22.2). Hospitalizations of patients less than 18 years of age were excluded from the study. This cohort was divided based on the secondary diagnosis of PEM. Outcomes analyzed included comparing inpatient mortality rates, mean length of hospital stay (LOS), mean hospitalization cost (THC), and rates of septic shock, acute myocardial infarction (AMI), acute respiratory failure (ARF), acute renal failure (AKI), acute pulmonary edema (PE) between the subgroups. Adjustments were made for age, sex, race, primary payer, median household income by zip code, Charlson Comorbidity Index (CCI), hospital location, bed-size, and teaching status using multivariate regression analysis. Statistical significance was set at a p-value < 0.05. Results There were 39,110 hospitalizations involving patients with SIADH as the reason for the admission in 2019, and 13.2% of them had comorbid PEM. While both cohorts had a higher proportion of females, the subgroup with comorbid PEM had a lower proportion of females comparatively (57.8 vs 62.3%, p=0.006). There was no significant difference in mean age (72.7±13.6 vs 72.1±12.2 years, p=0.113), but the cohort with PEM had a higher proportion of CCI >2 and more ethnic minorities. In patients with SIADH, PEM was associated with higher adjusted odds ratio (aOR) for mortality (2.53 vs 0.9%, aOR: 2.1, p=0.004), increased LOS (6.6 vs 4.7 days, p Conclusions Comorbid PEM was associated with increased odds of mortality, LOS, THC, septic shock, CVA, PE, and ARF in hospitalizations for SIADH. The mechanism of this association is unclear, but further studies are necessary to better understand this potentially important relationship. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

This retrospective cohort study examines the 30-day readmission rate for patients with hyperthyroidism. Analysis of data from the 2018 Nationwide Readmissions Database exposed factors that affect this rate and described key healthcare quality indices that are associated with these readmissions. Understanding these will help identify areas for improving patient outcomes. Presentation: Sunday, June 12, 2022 12:00 p.m. - 12:15 p.m.

Introduction Diabetes mellitus (DM) is known to cause hyponatremia via multiple mechanisms and is often a confounder in the diagnosis of the syndrome of inappropriate anti-diuretic hormone secretion (SIADH). However, not much is known about the prevalence of DM in patients with SIADH or the effect it has on outcomes of hospitalizations for SIADH. Method: Data was extracted from the US Nationwide Inpatient Sample (NIS) for 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for SIADH using the ICD-10-CM code (E22.2). We excluded hospitalizations of patients less than 18 years. This cohort was divided based on the secondary diagnosis of diabetes mellitus (DM). We compared inpatient mortality rates, mean length of hospital stay (LOS), mean hospitalization cost (THC), and rates of septic shock, acute myocardial infarction (AMI), acute respiratory failure (ARF), acute renal failure (AKI), and acute pulmonary edema (PE) between the subgroups. Adjustments were made for age, sex, race, primary payer, median household income by zip code, Charlson Comorbidity Index (CCI), hospital location, bed-size, and teaching status using multivariate regression analysis. Statistical significance was set at a p-value < 0.05. Results In 2019, there were 39,110 hospitalizations with SIADH as the reason for the admission. Comorbid DM was prevalent in 25.4% of these admissions. A higher proportion of hospitalizations involved females, with no significant difference between both cohorts (62.3 vs 60.1%, p=0.084). Patients with DM had a higher mean age (73.3±12 vs 72.4±13.8 years, p=0.005), a higher proportion of CCI >2, and a higher proportion of ethnic minorities. In patients with SIADH, DM was associated with no mortality difference (1.2% vs 0.9%, p=0.317) and no difference in LOS (4.9 vs 5.1 days, p=0.328) despite increased THC (10,873 vs 10,641 US$, p =0.03). Comorbid DM was associated with lower odds of AMI (0.4 vs 0.8%, aOR: 0.315, p=0.002), PE (0.15 vs 0.4%, aOR: 0.22, p=0.012) and ARF (6.8% vs 7.5%, aOR: 0.77, p=0.016), higher odds of AKI (15.9 vs 10.7, aOR: 1.23, p=0.008), with no significant difference in odds of septic shock or CVA. Conclusions Comorbid DM was associated with no difference in mortality or LOS despite an association with increased THC and AKI in hospitalizations of patients with SIADH. Notably, DM also appeared to lower the odds of AMI, PE, and ARF in this cohort of patients. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

The prevalence of obesity has increased worldwide leading to an increase in associated comorbidities and mortality. Endoscopic procedures are emerging treatments for obesity. We aimed to compare the outcomes of two of these procedures. This was a retrospective cohort study involving adults above 18 years old with morbid obesity admitted for either endoscopic vertical sleeve gastrectomy (EVSG) or endoscopic gastrojejunostomy (EGJ) in the US in 2019. We extracted data from the Nationwide Readmissions Database (NRD) in 2019, coding done with the International Classification of Diseases Tenth Revision, Clinical Modification (ICD10-CM). The study included hospitalizations with morbid obesity as the principal discharge diagnosis for index admission using ICD code E6601 excluding December hospitalizations and trauma admissions. This group was divided into EVSG (ICD: 0DB64Z3) and EGJ (ICD: 0D164ZA). Using unique identifiers, we obtained the index hospitalization and one subsequent hospitalization involving the same patient within 30 days as readmission. Outcomes included inpatient mortality, length of stay (LOS), and total hospital costs (THC) of the index hospitalization. We compared the 30-day all-cause readmission rate (ACR), the top 10 reasons for readmission, and independent predictors of readmission. We used multivariate Cox regression analysis to calculate the adjusted hazard ratio (aHR) to identify the independent predictors of readmission. The threshold for statistical significance was a p-value of Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 12:42 p.m. - 12:47 p.m.

Background: Implantable cardioverter-defibrillator (ICD) implantation is an invasive procedure that is associated with potential morbidity and mortality. Frail hospitalized older adults who are malnourished are potentially more susceptible. Quantifying the risk and benefit of ICD in different susceptible group is of interest to prevent inappropriate placement and assist with clinician-decision making. Objective: To examine the impact of protein energy malnutrition (PEM) on patients hospitalized for ICD placement. Methods: Data for this study was obtained from the combined Nationwide Inpatient Sample (NIS) 2016-2017. Primary outcome was inpatient all-cause mortality. Length of hospitalization (LOS), total hospital charges (THC), postprocedural complications (PPC), acute renal failure (ARF), and cerebrovascular accidents (CVA) were among the secondary outcomes of interest. Chi-square test was used for comparison between subgroups; multivariable regression analysis was used to adjust for confounders. Results: Of 108,195 hospitalizations for ICD placement, 4,015 (3.7%) had co-existing PEM. Post ICD placement, patients with co-existing PEM had higher inpatient mortality rate (5.4% vs 0.9%, p

Background We aimed to evaluate the characteristics of hospitalizations for radiation proctitis (RP). Methods The National Inpatient Sample (NIS) was analyzed to identify RP hospitalizations for 2016 and 2017. Outcomes included mortality, predictors of mortality, mean length of stay (LOS), mean total hospital cost (THC), and numerous system-based complications. Results We identified 16,810 adult hospitalizations for RP. On admission, an initial diagnosis of RP was established for only 27.54% of these patients. The mean age was 72.3±0.5 years and 30.2% of the study population was female. Whites made up 68.7% of the study population. Most hospitalizations for RP were at large (51%), urban (93.6%), and teaching (71.1%) hospitals. The inpatient mortality for RP hospitalizations was 1.7%. After adjusting for biodemographic factors, hospitalization characteristics and comorbidities, older age and protein energy malnutrition (PEM) were associated with higher odds of inpatient mortality. The mean LOS and THC for RP hospitalizations were 5.6 days and $53,800, respectively. Inpatient complications associated with RP included acute renal failure (19.7%), sepsis (4.4%), deep vein thrombosis (3.7%), acute respiratory failure (3.3%), and pulmonary embolism (0.7%). Conclusions Inpatient mortality for RP was 1.7%. Older age and PEM were associated with higher odds of inpatient mortality.

Introduction: Diabetic ketoacidosis (DKA) is a medical emergency associated with significant patient mortality and morbidity. Studies have shown that the presence of Major Depressive Disorder (MDD) is associated with an increased incidence of DKA. We aimed to assess whether MDD was associated with increased risk of readmission following DKA. Methods: We utilized the National Readmission Database for 2016 to identify hospitalized adult patients with a principal diagnosis of DKA and a secondary diagnosis of MDD from January 1 to November 30, 2016. We excluded patients with elective and traumatic admissions. We utilized a multivariate cox regression model to identify independent predictors of readmission. Results: Of 15,981 patients with MDD and DKA who were discharged, 23.2%(n=3710) were readmitted within 30-days. The most common reason for readmission was DKA (63.9%, n=2371). In the multivariate cox regression model, MDD was associated with higher risk of readmission (HR: 1.17, 95% CI: 1.1 - 1.26, p=0.04) when adjusted for comorbidities and hospital characteristics. Of those MDD patients with DKA who were readmitted, type 1 DM (HR: 1.14, 95% CI: 1 - 1.3, p=0.04), CHF (HR: 1.40, 95% CI: 1.1 - 1.78, p=0.006), and CKD (HR: 1.44, 95% CI: 1.17 - 1.79, p=0.001) were associated with higher risk of readmission. Obesity (HR: 0.75, 95% CI: 0.59 - 0.97, p=0.025), private insurance (HR: 0.64, 95% CI: 0.53 - 0.79, p Conclusion: In this study, we found that patients with MDD admitted for DKA had a 17% increased risk of readmission within 30 days of discharge in comparison to those without MDD. This could be explained by their propensity for poor adherence to diet, exercise, and recommended pharmacological therapy. Further studies need to be done to assess and target the exact precipitants of readmission. Disclosure M. Ramirez: None. M. Murthi: None. B. Sharma: None. R. Atluri: None. H. Shaka: None. G. Velazquez: None.

Introduction: With the increasing prevalence of diabetes mellitus (DM), there is an increasing burden of DM among pregnant women. Gestational DM (GDM), is a known complication of pregnancy which could affect the outcome for mother and child. This study looked into the burden of DM related gestations and readmissions. Methods: Data was obtained from the US National Readmissions Database for 2018, the largest database for readmissions in the US, which approximates yearly estimates. Index hospitalizations for DM complicating pregnancy and the postpartum period were obtained using ICD-10 codes. Hospitalizations less than 18 years of age and elective admissions were excluded. Outcomes included the rate of 30-day readmission (30DR) as well as identifying the commonest reasons for readmission among the studied cohort. Results: A total of 61,675 hospitalizations were included in the study as index admissions. Of these hospitalizations, 2,768 (4.50%) were readmitted within 30 days of discharge. The top reasons for readmission included severe pre-eclampsia, gestational DM, pre-existing DM type 1 in pregnancy, maternal care for scar from previous cesarean delivery, pre-existing DM type 2 in pregnancy and endometritis following delivery. Readmission was associated with increased healthcare utilization. Conclusion: Among pregnancies complicated by DM that led to hospitalization, a small proportion of patients get readmitted within 30 days for known complications of pregnancy. These could be associated with mortality, hence, research into factors and predictors of readmission in this population should be encouraged. Disclosure M. C. Aguilera: None. H. Shaka: None. C. D. Corpuz: None. M. Ramirez: None. S. T. Yap: None. P. O. Eseaton: None. M. Murthi: None.

Background: Obesity is one of the common comorbidities in patients with diastolic heart failure(HF). Though recognized as a risk factor for incidence of diastolic HF, the relationship of obesity to outcomes in patient with this diagnosis of is not clear and the obesity paradox has been suggested in the literature. Purpose The aim of this study was to compare the outcome of patient admitted for diastolic HF with and without obesity. Method: Data were obtained from The National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalization for diastolic HF as principal diagnosis with and without a secondary diagnosis of obesity using International Classification of Diseases, Tenth Revision (ICD-10) codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for possible confounders. Results: The combined 2016 and 2017 NIS database contained 367,395 hospitalizations for adult patients (aged ≥ 18 years) with a principal ICD-10 diagnosis for diastolic HF. Among this group, 107,790 (29%) had co-existing obesity. Of note, diastolic heart failure with obesity had decreased inpatient mortality that reached statistical significance (2.8% vs. 1.4%, AOR:0.71, 95% CI 0.62-0.81, p Conclusion: Patients admitted for diastolic heart failure with co-existing obesity have reduced inpatient mortality compared to those without obesity. However, Total hospital charges and LOS were increased in the obesity group compared to the patient without obesity. Further prospective studies on this topic are needed. Disclosure I. R. Asemota: None. H. Shaka: None. M. Almani: None. E. Akuna: None. E. Edigin: None.

Background: Diabetes mellitus (DM) is a multisystem metabolic disorder shown to have adverse effects on lung physiology, immune responses, and antimicrobial defenses. However, the impact of DM on the development of poor in-hospital outcomes in patients with Acute COPD exacerbation (AECOPD) is unclear. We aimed to assess this very impact in our study. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2018. About 394,929 hospitalizations had AECOPD as a primary diagnosis and were stratified based on the presence of DM using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and analyze variables. The selection of covariates was done with a univariate screen and literature review. Results: Out of the 394,929 hospitalized patients with AECOPD, 123,425 patients had DM. In-hospital mortality in AECOPD patients with DM was lower than those without (0.78% vs. 1.17%, p Conclusion: DM in AECOPD did not have worse outcomes in terms of in-hospital mortality, LOS, and PC. DM patients had lower risk of MI, PE, and stroke, however, had higher risk of AKI. Further investigation is needed to understand the exact correlation between the paradoxical nature of outcomes in AECOPD in those with DM. Disclosure R. Atluri: None. M. Ramirez: None. H. Shaka: None. M. Murthi: None. C. D. Corpuz: None. S. Velagapudi: None. G. Velazquez: None.

Introduction: Hyperglycemic hyperosmolar state is an endocrinological emergency associated with type 2 diabetes (T2DM) patients. HHS is associated with significant morbidity and mortality. The burden of HHS, however, does not end with the index admission. This study sought to determine the rate, reasons and predictors of 30-day readmissions (30DR) in T2DM patients with index admission for HHS with the goal of identifying potentially modifiable factors to decrease the burden of readmissions. Methods: The US Readmission database for 2018 was searched for index hospitalizations involving adult patients with T2DM who had HHS in 2018. Outcomes assessed included 30DR rates, top principal diagnosis for readmitted patients, comparison of mortality, length of stay (LOS), and hospitalization costs (THC), and predictors of 30DR. Results: A total of 21,721 hospitalizations involved adults with T2DM with HHS during the index admissions. The 30DR rate was 13.77%. The most common reasons for readmission was DM type 2 with hyperglycemia (8.6%), DKA (8.1%), HHS (8.0%), sepsis unspecified (7.9%), and acute renal failure (4.2%). Readmission was associated with higher odds of mortality (2.55% vs. 0.65%, OR: 4.00, 95% CI: 2.63 - 6.07), longer LOS (5.8 vs. 3.9 days, p Conclusion: HHS is associated with significant complications following the index admission. 30DR is associated with increased mortality and healthcare utilization in this population. Proper discharge planning and addressing factors associated with readmissions would likely improve outcome in this population. Disclosure H. Shaka: None. M. C. Aguilera: None. S. T. Yap: None. M. Ramirez: None. C. D. Corpuz: None. E. Edigin: None. P. E. Ojemolon: None. I. R. Asemota: None. E. Akuna: None.

Introduction: Diabetes mellitus (DM) is the commonest cause of nontraumatic amputation worldwide. With increasing prevalence of DM, there has been an increase in the rate of below the knee amputations (BKA), usually in the setting of severe soft tissue infections and osteomyelitis. Readmissions are often related to prior admissions and account for significant and usually preventable healthcare cost burden. This study assessed the rate and reasons for 30-day readmissions (30DR) in DM patients with BKA with the aim of identifying preventable factors for readmissions. Methods: The National Readmission Database for 2018 was queried for hospitalizations involving adult patients with DM who had BKA from January 1 to November 30, 2018. Elective and traumatic admissions were excluded. Outcomes assessed were 30DR rates, mortality, length of stay (LOS), hospitalization costs (THC) and top principal diagnosis for readmitted patients following BKA. Results: A total of 15,090 hospitalizations involved adults with DM who had DKA as index admissions. The 30DR rate was 13.79%. The most common reasons for readmission were sepsis unspecified (18.4%), hypertension with CKD and heart failure (7.0%), DM angiopathy with gangrene (4.2%), acute renal failure (3.0%), and hypertension with heart failure (2.1%). Readmission was associated with higher odds of mortality (6.1% vs. 4.3%, OR: 1.45, 95% CI: 1.11 - 1.89, p=0.007) compared to the index admission. In patients with DM with BKA, readmissions accounted for a cumulative 18,078 days of hospitalization, which cost patients over $40 million within the period. Conclusion: A significant proportion of patients with DM with BKA are readmitted for various complications. 30DR is associated with higher mortality and result in a significant cost burden to the patient and healthcare system. Mitigating the rate or readmissions would significantly improve patient outcomes. Disclosure C. D. Corpuz: None. H. Shaka: None. M. Ramirez: None. M. C. Aguilera: None. S. T. Yap: None. A. Kichloo: None. M. Murthi: None. R. Atluri: None. S. Gonakoti: None.

Background: Diabetes and Congestive Heart Failure frequently coexist in the same patients. This aim of the study was to compare the adverse outcome rates of diabetic patient admitted for hyperosmolar hyperglycemic state with concomitant heart failure compared to those without heart failure. Method: Data were obtained from The National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalization for HF as principal diagnosis with and without a secondary diagnosis of diabetes mellitus type 2 with hyperglycemic hyperosmolar state (DM2 with HHS) using International Classification of Diseases, Tenth Revision (ICD-10) codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for possible confounders. Results: The combined 2016 and 2017 NIS database contained 2,586,684 hospitalizations for adult patients (aged ≥ 18 years) with a principal ICD-10 diagnosis for DM2 with HHS. Among this group, 500 (1.1%) had co-existing HF. Of note, patient admitted for HHS with secondary diagnosis of HF had increased inpatient mortality but did not reach statistical significance (2.0% vs. 0.7%, AOR:1.66, 95% CI 0.41-6.67, p Conclusion: Patients admitted for HHS with co-existing heart failure have similar inpatient mortality, however Total hospital charges and LOS were increased in those with HF compared to the patients without HF. Patients with concomitant heart failure and diabetes have diverse pathophysiological mechanism that may contribute to worse outcomes that need to be explored further. Disclosure I. R. Asemota: None. H. Shaka: None. E. Edigin: None. M. Almani: None. E. Akuna: None.

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM), associated with significant mortality. Patients frequently develop a constellation of electrolyte disturbances, including hypocalcemia. We wanted to analyze the in-hospital outcomes of DKA patients with hypocalcemia. Methods: We conducted a retrospective observational study using the National Inpatient Sample (NIS) from 2017 and 2018. Patients with type 1 and 2 DM with a principal diagnosis of DKA were selected and stratified based on the presence of hypocalcemia. The primary outcome was in-hospital mortality. The secondary outcomes included the development of sepsis, acute kidney injury (AKI), Acute respiratory failure(ARF), cerebral edema (CE), length of stay (LOS), and total charges. Confounders were adjusted for using multivariate regression analysis. We included AKI and Sepsis in the multivariate analysis for mortality since hypocalcemia can be seen in both conditions. Results: Out of 379,614 DKA admissions during the study period, 6894(1.8%) had hypocalcemia. When adjusted to patient characteristics, co-morbidities and hospital characteristics, those with hypocalcemia had higher odds of AKI (aOR=1.28, CI=1.13-1.45, p= Conclusion: Hypocalcemia is associated with increased odds of mortality in patients admitted with DKA and it could be used as a disease severity marker. Further studies need to be done to determine if hypocalcemia in DKA is merely a predictive factor or a direct contributor to increased mortality. Disclosure M. Murthi: None. C. D. Corpuz: None. S. Velagapudi: None. M. Ramirez: None. R. Atluri: None. H. Shaka: None.