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. 2021 Dec 31;16(1):1365-1376.
doi: 10.1515/biol-2021-0141. eCollection 2021.

Novel predictor of the occurrence of DKA in T1DM patients without infection: A combination of neutrophil/lymphocyte ratio and white blood cells

Yiping Cheng  1   2   3   4 , Wenhao Yu  5 , Yuping Zhou  6 , Tao Zhang  5 , Haiyan Chi  6 , Chao Xu  1   2   3   4
Affiliations

Novel predictor of the occurrence of DKA in T1DM patients without infection: A combination of neutrophil/lymphocyte ratio and white blood cells

Yiping Cheng et al. Open Life Sci. .

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.

Keywords: diabetic ketoacidosis; lymphocytes; white blood cells.

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Conflict of interest statement

Conflict of interest: The authors state no conflict of interest.

Figures

Figure 1
Figure 1
Differences in NLR and WBC levels among the four groups. Serum NLR and WBC levels of T1DM patients are significantly higher than that of normal controls and if DKA occurs, the NLR and WBC levels increase further and increase with the severity of DKA. Abbreviation: NLR, neutrophil/lymphocyte ratio; WBC, white blood cells; Non-DKA group: T1DM patients in an uninfected state without ketosis or ketoacidosis. Mild-DKA group: T1DM patients with ketosis and in an uninfected state. Severe-DKA group: T1DM patients with ketoacidosis and in an uninfected state.
Figure 2
Figure 2
ROC curve of the predicted variables associated with the occurrence of DKA in T1DM patients. The diagnosis analysis showed that except for NLR and WBC, the area under curve (AUC) of indicators with the 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 addition of inflammation indicators can play a statistically significant gain in the prediction model of the occurrence of DKA. Abbreviation: ROC, receiver operating characteristic curve analysis; NLR, neutrophil/lymphocyte ratio; WBC, white blood cells. Differences with a probability value of p < 0.05 were considered statistically significant.
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