Endocrine Abstracts

Introduction: Inflammation has been involved in the physiopathology of diabetic ketoacidosis (DKA). Hematological inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and white blood cell count (WBC) can serve as predictive markers for a systemic inflammatory response. This study aimed to evaluate hematological inflammatory markers in T1DM patients with DKA and without-DKA in an uninfected state and to determine their role in the prediction of DKA.

Patients and Methods: This is a retrospective preliminary study including a total of 30 T1DM uninfected patients. According to the onset characteristics, fasting blood glucose, ketone bodies, and blood gas analysis results, patients were divided into T1DM patients with DKA (n=7) and without-DKA (n=23) groups. Hematological inflammatory markers including WBC, NLR, PLR (platelet-to-lymphocyte ratio) and PNR (platelet-to-neutrophil ratio) were retrieved from complete blood counts.

Results: The median age of T1DM patients was 24.5 years [14-45]. The mean level of WBC was higher in T1DM patients with DKA than those without-DKA (11881.4±6971.36 vs 8191.3 ±3210.36; P=0.21). T1DM patients with DKA had significantly higher serum NLR levels than those without DKA (9.71±8.85vs 2.30 ±1.05; P=0.035). NLR was also significantly associated with the occurrence of DKA in T1DM patients (OR=2.18, 95%CI: 1.5–4.4, P=0.034). Furthermore, the levels of NLR were positively correlated with the circulating levels of creatinine (r=0.5; P=0.008) and negatively correlated with the circulating levels of albumin (r=-0.55; P=0.01). The mean level of PNR was significantly lower in patients with DKA than those without DKA (25.99 ±14.96 vs 55.82 ±20.77; P=0.001). The mean level of PLR was higher in patients with DKA than those without DKA (171.6 ±93.54 vs 119.33±41.59; P=0.19). The ability of WBC, NLR, PLR and PNR in predicting DKA was analyzed using ROC curves. The most influential indicator for DKA patients was NLR (AUC 0.85; 95%CI: 0.7–1;p <0.005). The statistical threshold value of the NLR in predicting DKA was 2.05, with a sensitivity of 100% and a specificity of 50%.

Conclusion: Our findings indicate that the levels of WBC, NLR, and PLR were elevated in uninfected T1DM patients with DKA. The involvement of neutrophil-mediated inflammation may contribute to the pathogenesis of DKD in T1DM. Consequently, NLR can serve as a practical and cost-effective predictor for the occurrence of DKA in T1DM patients.