Department of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Diabetes Care. 2011 Apr;34(4):852-4. doi: 10.2337/dc10-1844. Epub 2011 Feb 9.
In the emergency department, hyperglycemic patients are screened for diabetic ketoacidosis (DKA) via a urine dipstick. In this prospective study, we compared the test characteristics of point-of-care β-hydroxybutyrate (β-OHB) analysis with the urine dipstick.
Emergency-department patients with blood glucose ≥250 mg/dL had urine dipstick, chemistry panel, venous blood gas, and capillary β-OHB measurements. DKA was diagnosed according to American Diabetes Association criteria.
Of 516 hyperglycemic subjects, 54 had DKA. The urine dipstick had a sensitivity of 98.1% (95% CI 90.1-100), a specificity of 35.1% (30.7-39.6), a positive predictive value of 15% (11.5-19.2), and a negative predictive value of 99.4% (96.6-100) for DKA. Using the manufacturer-suggested cutoff of >1.5 mmol/L, β-OHB had a sensitivity of 98.1% (90.1-100), a specificity of 78.6% (74.5-82.2), a positive predictive value of 34.9% (27.3-43), and a negative predictive value of 99.7% (98.5-100) for DKA.
Point-of-care β-OHB and the urine dipstick are equally sensitive for detecting DKA (98.1%). However, β-OHB is more specific (78.6 vs. 35.1%), offering the potential to significantly reduce unnecessary DKA work-ups among hyperglycemic patients in the emergency department.
在急诊科，通过尿试纸对高血糖患者进行糖尿病酮症酸中毒（DKA）筛查。在这项前瞻性研究中，我们比较了即时检测β-羟丁酸（β-OHB）分析与尿试纸的检测特性。
血糖≥250mg/dL 的急诊科患者进行尿试纸、化学面板、静脉血气和毛细血管β-OHB 测量。根据美国糖尿病协会标准诊断 DKA。
在 516 例高血糖患者中，有 54 例患有 DKA。尿试纸的灵敏度为 98.1%（90.1-100），特异性为 35.1%（30.7-39.6），阳性预测值为 15%（11.5-19.2），阴性预测值为 99.4%（96.6-100）。使用制造商建议的>1.5mmol/L 截断值，β-OHB 的灵敏度为 98.1%（90.1-100），特异性为 78.6%（74.5-82.2），阳性预测值为 34.9%（27.3-43），阴性预测值为 99.7%（98.5-100）。
即时检测β-OHB 和尿试纸在检测 DKA 方面同样敏感（98.1%）。然而，β-OHB 的特异性更高（78.6 比 35.1%），有可能显著减少急诊科高血糖患者中不必要的 DKA 检查。
