Naunheim Rosanne, Jang Timothy J, Banet Gerald, Richmond Alec, McGill Janet
Department of Emergency Medicine, Washington University, St. Louis, MO, USA.
Acad Emerg Med. 2006 Jun;13(6):683-5. doi: 10.1197/j.aem.2006.01.020. Epub 2006 May 11.
Diabetic ketoacidosis (DKA) is a common, life-threatening complication of diabetes. The diagnosis of DKA relies on signs and symptoms, plus laboratory findings of blood glucose (BG) of > 250 mg/dL, an anion gap (AG) of > or = 15 mmol/L, and carbon dioxide (CO2) of < or = 18 mmol/L when other causes of acidosis are excluded.
To compare the results of a point-of-care test for the ketone beta-hydroxybutyrate (beta-OHB) with standard measures for accuracy in predicting DKA.
After providing informed consent, 160 patients who presented with BG of > 250 mg/dL underwent testing for beta-OHB with the Precision Xtra meter (Abbott Laboratories, North Chicago, IL) at triage in a large urban hospital emergency department. The diagnosis of DKA was made by clinicians by using standard clinical criteria without knowledge of the beta-OHB test.
A diagnosis of DKA was made in 57 of 160 subjects. The beta-OHB values correlated strongly with AG (r = 0.66, p < 0.001) and with CO2 (r = -0.69, p < 0.001), as well as with glucose (r = 0.31, p < 0.001). Cross-classification of DKA vs. beta-OHB yielded sensitivity of 98% (95% CI = 91% to 100%), specificity of 85% (95% CI = 78% to 91%), with a positive likelihood ratio of 6.7 (95% CI = 4.22 to 10.78), and negative likelihood ratio of 0.021 (95% CI = 0.003 to 0.144) at the manufacturer-suggested beta-OHB level of 1.5.
The point-of-care test for beta-OHB was as sensitive as more established indicators of DKA. It is more useful than glucose alone for the diagnosis of DKA and offers immediate diagnosis of patients at triage.
糖尿病酮症酸中毒（DKA）是糖尿病常见的、危及生命的并发症。DKA的诊断依赖于体征和症状，以及实验室检查结果，即血糖（BG）>250mg/dL、阴离子间隙（AG）≥15mmol/L，且排除其他酸中毒原因时二氧化碳（CO₂）≤18mmol/L。
比较酮体β-羟基丁酸（β-OHB）即时检测结果与预测DKA的标准检测方法的准确性。
在获得知情同意后，160例血糖>250mg/dL的患者在一家大型城市医院急诊科分诊时使用Precision Xtra血糖仪（雅培实验室，美国伊利诺伊州北芝加哥）进行β-OHB检测。临床医生根据标准临床标准诊断DKA，且对β-OHB检测结果不知情。
160例受试者中有57例被诊断为DKA。β-OHB值与AG（r = 0.66，p < 0.001）、CO₂（r = -0.69，p < 早筛诊断中，对患者进行即时诊断很有用。 0.001）以及血糖（r = 0.31，p < 0.001）密切相关。DKA与β-OHB的交叉分类显示，在制造商建议的β-OHB水平为1.5时，敏感性为98%（95%CI = 91%至100%），特异性为85%（95%CI = 78%至91%），阳性似然比为6.7（95%CI = 4.22至10.78），阴性似然比为0.021（95%CI = 0.003至0.144）。
β-OHB即时检测与更成熟的DKA指标一样敏感。它在DKA诊断中比单独检测血糖更有用，且在分诊时能为患者提供即时诊断。
