The Ratio of Red Cell Distribution Width to Mean Corpuscular Volume in Patients with Diabetic Ketoacidosis

Abstract

The relationship between erythrocyte parameters and diabetic ketoacidosis (DKA) remains uncertain. This study aimed to investigate the potential role of erythrocyte indices in type 1 diabetes (T1D) patients with DKA. This study included 48 patients with T1D, 26 patients with DKA, and 30 age- and gender-matched controls. Erythrocyte parameters were measured and evaluated at the time of admission and after treatment. Data were analyzed by One-Way ANOVA Tukey analysis with SPSS software. The DKA patients had higher levels of plasma glucose (28.87 +/- 9.01 mmol/L), HbA1c (13.08 +/- 3.10%), osmotic pressure (332.11 +/- 11.67 mosm/L), red cell distribution width (RDW, 41.24 +/- 3.08 fL), and the RDW to mean corpuscular volume (MCV) ratio (47.50 +/- 3.70%) compared to non-DKA cases and controls (all p < 0.05). Pearson's correlation test showed that osmolality was positively correlated with plasma glucose (r = 0.699, p < 0.001) and negatively correlated with mean corpuscular hemoglobin concentration (MCHC) (r = -0.409, p = 0.049). Receiver operating characteristic curve analyses demonstrated that the areas under the curves were 0.924 for the RDW/MCV ratio and 0.802 for RDW in the ability of reflecting DKA (z = 2.086, p = 0.0369). A logistic regression revealed that the RDW/MCV ratio can act as a robust risk marker for the presence of DKA (OR = 1.548, p = 0.0360, 95% CI: 1.029 - 2.330). The RDW returned to normal, and plasma glucose levels and metabolic acidosis were well controlled following treatment. The RDW and the RDW/MCV ratio were significantly correlated with DKA. The RDW/MCV ratio can act as a robust biomarker that is more sensitive than RDW in reflecting the presence of DKA.