SUN-569 - Hypoglycemia as an Independent Predictor for Hospital Outcomes of Patients with Delirium Tremens: Insight From a National Database Analysis

Aims: Patients with alcohol withdrawal syndrome (AWS) may have a higher risk of hypoglycemia due to poor oral intake and alcohol-induced glucose metabolism abnormalities. However, this issue in patients with delirium tremens (DT), has not been well studied. This study aims to investigate the hospital outcomes of DT patients who experienced hypoglycemia and factors associated with hypoglycemia in this population.

Methods: We conducted a retrospective observational study on the United States National Inpatient Sample from 2017 to 2022, using Stata 19.5 and ICD-10 codes to identify adults ≥18 years old hospitalized for DT (F10.231) stratified by hypoglycemia with blood glucose level < 70 mg/dl (E16.2) and non-hypoglycemia. Primary outcomes are all-cause hospital mortality, endotracheal intubation rate, and hospital length of stay (LOS). Survey-weighted multivariate regression was used to analyze the association between clinical variables and outcomes, followed by inverse probability of treatment weighting (IPTW) and augmented inverse probability weighting (AIPW) for sensitivity/robustness check.

Results: Among 272,345 weighted DT admissions, 5,105 cases (1.87%) had hypoglycemia. Age distribution and Charlson’s comorbidity indices were insignificantly different between the two groups. The hypoglycemic group had a higher rate of acute kidney injury (AKI) (19.5% vs 11.9%), liver cirrhosis (38.4% vs 31.9%), and sepsis (4.5% vs 2.3%) than the non-hypoglycemic group, p< 0.01. Diabetes mellitus (DM) (0.2% vs 9.4%) and obesity (4.0% vs 7.8%) were less common in the former than the latter group, p< 0.01. A higher rate of endotracheal intubation (10.6% vs 6.0%), longer LOS (8.4 vs 6.2 days), and more mortality (1.6% vs 0.5%) were seen in the hypoglycemic than the non-hypoglycemic group, p< 0.01. Hypoglycemia was associated with a higher odds ratio (OR) of mortality and intubation by 2.26 and 1.84, respectively, and prolonged LOS by 29.6%, p< 0.01. After applying IPTW and AIPW to control confounding, hypoglycemia remained strongly associated with a higher intubation rate (3.8%, p< 0.01) and longer LOS (35.4%, p< 0.01) but became insignificantly associated with mortality (0.5%, p=0.142).

Compared with White patients, Black patients had a higher OR of hypoglycemia by 1.76, p< 0.01. Patients in the Mountain region had a higher OR of hypoglycemia than those in New England by 1.51, p=0.028. Other factors associated with a higher risk of hypoglycemia included AKI (OR 1.73), liver cirrhosis (OR 1.34), and sepsis (OR 1.75), p< 0.01. Protective factors from hypoglycemia were D (OR 0.02, p< 0.01) and obesity (OR 0.53, p=0.001).

Conclusion: Hypoglycemia is a strong independent predictor for morbidity rather than mortality in patients with DT. Blood sugar monitoring and hypoglycemic prophylactic strategies should target vulnerable patients to improve the hospital outcomes of this population.

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