Marked elevation of plasma procalcitonin levels in patients with diabetic ketoacidosis: A possible useful diagnostic biomarker

Anno, Takatoshi; Shigemoto, Ryo; Kawasaki, Fumiko; Irie, Shintaro; Miyashita, Naoyuki; Kaku, Kohei; Kaneto, Hideaki

doi:10.1016/j.diabet.2019.05.006

Cited by 7 publications

(8 citation statements)

References 6 publications

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“…In our study, we found an elevated a high level of PCT in patients without any proven bacterial infection, with a PCT drop following normalization of glycemia. High PCT levels were recently reported in different case reports or case series focusing on diabetes ketoacidosis without infection [33,34]. A case series of 5 patients hospitalized for diabetes ketoacidosis reported PCT levels ranging from 6.87 to 30.47 ng/mL.…”

Section: Discussionmentioning

confidence: 91%

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Early sepsis markers in patients admitted to intensive care unit with moderate-to-severe diabetic ketoacidosis

Blanchard

Charbit

Meersch

et al. 2020

Ann. Intensive Care

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Background: Bacterial infections are frequent triggers for diabetic ketoacidosis. In this context, delayed antibiotic treatment is associated with increased morbidity and mortality. Unnecessary administration of antimicrobial therapy might however, also negatively impact the prognosis. The usefulness of sepsis markers in diabetic ketoacidosis has not been assessed. Thus, we sought to investigate diagnostic performances of clinical and biological sepsis markers during diabetic ketoacidosis. Methods: In this monocentric retrospective cohort study, all consecutive episodes of diabetic ketoacidosis (defined as pH ≤ 7.25, glycaemia > 300 mg/dL and presence of ketones) admitted in intensive care unit were included. A proven bacterial infection was defined as bacteriological documentation on any bacterial sample. Clinical (presence of fever: temperature > 38 °C and presence of hypothermia: temperature < 36 °C) and biological markers (whole blood count, neutrophils count, neutrophils-to-lymphocytes count ratio and procalcitonin), recorded at admission, were compared according to the presence or absence of a proven bacterial infection. Results: Between 2011 and 2018, among 134 episodes of diabetic ketoacidosis, 102 were included (91 patients). Twenty out of 102 were infected. At admission, procalcitonin (median: 3.58 ng/mL vs 0.52 ng/mL, p < 0.001) and presence of fever (25% vs 4%, p = 0.007) were different between episodes with and without proven bacterial infection in both univariate and multivariate analysis. Whole blood count, neutrophils count, neutrophils-to-lymphocytes count ratio and presence of hypothermia were not different between both groups. The diagnostic performance analysis for procalcitonin revealed an area under the curve of 0.87 with an optimal cutoff of 1.44 ng/mL leading to a sensitivity of 0.90 and a specificity of 0.76. Combining procalcitonin and presence of fever allowed to distinguish proven bacterial infection episodes from those without proven bacterial infection. Indeed, all patients with procalcitonin level of more than 1.44 ng/mL and fever had proven bacterial infection episodes. The presence of one of these 2 markers was associated with 46% of proven bacterial infection episodes. No afebrile patient with procalcitonin level less than 1.44 ng/ mL had a proven bacterial infection. Conclusion: At admission, combining procalcitonin and presence of fever may be of value to distinguish ketoacidosis patients with and without proven bacterial infection, admitted in intensive care unit.

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Section: Discussionmentioning

confidence: 91%

“…Interestingly, this observation was not found in case of hyperosmolar hyperglycemic syndrome. This led the author to conclude that the augmentation of PCT in acute glycemic crisis may only be found during diabetes ketoacidosis [34].…”

Section: Discussionmentioning

confidence: 99%

Early sepsis markers in patients admitted to intensive care unit with moderate-to-severe diabetic ketoacidosis

Blanchard

Charbit

Meersch

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

“…In our study, we also reported a high level of PCT in patients without infection, with a PCT drop following normalization of glycaemia. High PCT levels were recently reported in different case reports or case series focusing on diabetes ketoacidosis without infection [32,33]. A case series of 5 patients hospitalized for diabetes ketoacidosis reported PCT levels ranging from 6.87 to 30.47 ng/mL.…”

Section: Discussionmentioning

confidence: 91%

“…This led the author to conclude that the augmentation of PCT in acute glycemic crisis may only be found during diabetes ketoacidosis [33].…”

Section: Discussionmentioning

confidence: 99%

Early sepsis markers in patients admitted to intensive care unit with moderate to severe diabetic ketoacidosis

Blanchard

Charbit

Meersch

et al. 2019

Preprint

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Background Bacterial infections are frequent triggers for diabetic ketoacidosis. In this context, delayed antibiotic treatment is associated with increase morbidity and mortality. Unnecessary administration of antimicrobial therapy might however also negatively impact the prognosis. The usefulness of traditional sepsis markers in diabetic ketoacidosis has not been assessed. Thus, we sought to investigate diagnostic performances of clinical and biological sepsis markers during diabetic ketoacidosis. Methods Patients admitted in a single intensive care unit for diabetic ketoacidosis (defined by pH < 7.3 and glycaemia > 13.75mmol/L) were retrospectively analyzed. Clinical and biological markers were evaluated to determine their ability to identify infected from non-infected patients. Results Between 2011 and 2018, among 134 episodes of diabetic ketoacidosis, 102 were included (91 patients). Twenty out of 102 were infected. At admission, procalcitonin (median: 3.58ng/mL vs 0.52ng/mL, p<0.001) and presence of fever, defined as temperature > 38°C, (25% vs 2.5%, p=0.007) were different between infected patients and non-infected patients in both univariate and multivariate analysis. Whole blood count, neutrophils count and presence of hypothermia were not different between both groups. The diagnostic performance analysis for procalcitonin revealed an area under the curve of 0.87 with an optimal cutoff of 1.44ng/mL leading to a sensibility of 0.90 and a specificity of 0.76. Combining procalcitonin and presence of fever allowed distinguish infected from non-infected patients. Indeed, all patients with procalcitonin level of more than 1.44ng/mL and fever were infected patients. The presence of one of these 2 markers was associated with 46% of infected patients. No afebrile patient with procalcitonin level less than 1.44 ng/mL was infected. Conclusion At admission, combining procalcitonin with a threshold above 1.44 ng/mL and presence of fever may be of value to distinguish infected from non-infected patients admitted in intensive care unit for diabetes ketoacidosis.

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“…Ivaska et al reported that when children with type 1 DM develop DKA, the PCT levels are high despite the absence of infection ( 10 ). Two studies have reported a PCT elevation after DKA in adults with type 1 DM ( 10 , 11 ). Information regarding these eight previously reported cases is presented in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

A Remarkable Elevation in the Procalcitonin Levels Due to Diabetic Ketoacidosis in a Hemodialysis Patient

et al. 2021

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Procalcitonin (PCT), a marker of the inflammatory response during infections, can be elevated by diabetic ketoacidosis (DKA). A male patient in his 50s with diabetic nephropathy on hemodialysis presented with vomiting and a reduced level of consciousness and was diagnosed with DKA. His PCT level was markedly elevated, but bacterial cultures (blood, urine, and stool) were negative. The PCT level decreased after DKA improvement. In this patient, DKA probably enhanced the PCT levels. As DKA can increase the PCT levels, an elevation of the PCT levels in DKA patients may not be indicative of infectious diseases, and noninfectious causes of DKA should therefore be considered.

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Marked elevation of plasma procalcitonin levels in patients with diabetic ketoacidosis: A possible useful diagnostic biomarker

Cited by 7 publications

References 6 publications

Early sepsis markers in patients admitted to intensive care unit with moderate-to-severe diabetic ketoacidosis

Early sepsis markers in patients admitted to intensive care unit with moderate-to-severe diabetic ketoacidosis

Early sepsis markers in patients admitted to intensive care unit with moderate to severe diabetic ketoacidosis

A Remarkable Elevation in the Procalcitonin Levels Due to Diabetic Ketoacidosis in a Hemodialysis Patient

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