Abstract
The role of inflammation has been identified in the pathogenesis of diabetic ketoacidosis (DKA). The neutrophil/lymphocyte ratio (NLR) and white blood cells (WBC) can be used to predict a systemic inflammatory response. Changes in NLR and WBC levels have never been explored in type 1 diabetes mellitus (T1DM) patients with DKA and an uninfected state. This retrospective study included a total of 644 participants. NLR and WBC were measured in the control group (n = 316) and in T1DM patients with mild-DKA (n = 92), severe-DKA (n = 52), and non-DKA (n = 184) in an uninfected state. Then, we assessed the independent predictors of DKA occurrence in T1DM patients in an uninfected state. The diagnostic performance of variables was determined by receiver operating characteristic curve analysis. Serum NLR of T1DM patients is significantly higher than that of normal controls, and if DKA occurs, NLR increases further and increases with the severity of DKA. In addition to diastolic blood pressure, blood urea nitrogen, glycated hemoglobin (HbA1c), and WBC, NLR was also independently associated with DKA in T1DM patients with an uninfected state (OR = 1.386, 95% CI: 1.127–1.705, p = 0.002). Furthermore, the diagnosis analysis showed that except for NLR and WBC, the area under the curve (AUC) of indicators with a statistical difference in patients with and without DKA were 0.747 for DKA diagnosis, and after the addition of NLR and WBC, the AUC was 0.806. The increased NLR level represents a low-cost and highly accessible predictor for DKA in T1DM patients with an uninfected state. The addition of inflammation indicators can play a statistically significant role in the prediction model of the DKA occurrence.
Highlights
Diabetic ketoacidosis (DKA) is an acute and severe complication of diabetes, and DKA is more likely to occur in type 1 diabetes mellitus (T1DM)
We first analyzed the differences in clinical indicators of the normal control group (n = 316) and T1DM patients in an uninfected state with non-DKA (n = 184), mild-DKA (n = 92), and severe-DKA (n = 52) groups (Table 1)
The ALB level of T1DM patients decreased compared with the control group
Summary
Diabetic ketoacidosis (DKA) is an acute and severe complication of diabetes, and DKA is more likely to occur in type 1 diabetes mellitus (T1DM). Early detection and treatment of DKA are beneficial to the prognosis of diabetic patients [1,2]. Some patients with T1DM may develop DKA and other acute diabetic complications due to irregular use of insulin or the induction of diseases such as infection [3,4]. These patients may have systemic oxidative stress or inflammatory response, which exacerbates the disorder of the patient’s internal environment [5]. DKA in T1DM patients without infection is an uninfected form of systemic inflammatory response syndrome with significantly increased proinflammatory factors [6]. The identification of the exact relationship between inflammatory response and DKA is significant for the early treatment and later recovery of DKA patients
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