COVID-19 infection may cause ketosis and ketoacidosis.

This study included 658 hospitalized patients with confirmed COVID-19. Forty-two (6.4%) out of 658 patients presented with ketosis on admission with no obvious fever or diarrhea. They had a median age of 47.0 years (IQR, 38.0-70.3), while 16 (38.1%) were men. Patients with ketosis were younger (median age: 47.0 vs 58.0 years, P = 0.003) and had greater prevalence of fatigue (31.0% vs 10.6%, P < 0.001), diabetes (35.7% vs 18.5%, P = 0.007), and digestive disorders (31.0% vs 12.0%, P < 0.001). However, they had longer length of hospital stay (19.0 [12.8-33.3] days vs 16.0 [10.0-24.0] days, P < 0.001) and higher mortality rate (21.4% vs 8.9%, P = 0.017). Three (20.0%) out of the 15 cases with diabetic ketosis developed acidosis, 5 cases (26.7%) with diabetic ketosis died, and one (25.0%) of the deaths presented with acidosis. Two (7.4%) and four (14.3%) cases of the 27 non-diabetic ketotic patients developed severe acidosis and died, respectively, and one (25.0%) of the deaths presented with acidosis. This suggested that COVID-19 infection caused ketosis or ketoacidosis, and induced DKA for those patients with diabetes. Ketosis increased the length of hospital stay and mortality. Meanwhile, diabetes increased the length of hospital stay for patients with ketosis but had no effect on their mortality. This article is protected by copyright. All rights reserved.