Huang et al identified factors identifying infection as the cause of diabetic ketoacidosis (DKA). This can help to clarify the underlying cause for an episode. The authors are from University of Science and Technology of China in Hefei, China.
Patient selection: diabetic ketoacidosis (DKA)
Predictors for infection:
(1) white blood cell count > 10 * 10^9/L (OR 4.1)
(2) serum procalcitonin to lactate ratio > 0.438 (OR 7.7)
procalcitonin to lactate ratio = PLR =
= (serum procalcitonin in ng/mL) / (serum lactate in mmol/L)
Other factors:
(1) elevated serum CRP in mg/L
(2) higher percent neutrophils in the differential count
Performance:
• The area under ROC curve was 0.91 for PLR.
• The area under ROC curve was 0.81 for leukocytosis.
NOTE: An elevated serum procalcitonin alone is not diagnostic of infection as it may be elevated in ketoacidosis not caused by infection (Mohammed et al).
