血浆β-羟丁酸在糖尿病酮症酸中毒缓解定义中的作用。
Utility of plasma beta-hydroxybutyrate to define resolution of diabetic ketoacidosis.
机构信息
Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Pediatr Diabetes. 2022 Dec;23(8):1621-1627. doi: 10.1111/pedi.13437. Epub 2022 Oct 29.
BACKGROUND
Diabetic ketoacidosis (DKA) is a common, life-threatening complication of type 1 diabetes (T1D) characterized by unregulated ketogenesis caused by relative or absolute insulin deficiency. DKA management requires frequent biochemical monitoring. Plasma ß-hydroxybutyrate (BOHB) has not been included in traditional definitions of DKA resolution.
OBJECTIVE
The aim of this study was to determine a cut-point level of BOHB to define DKA resolution in patients with T1D treated with intravenous (IV) insulin.
SUBJECTS
We identified patients with T1D receiving IV insulin for DKA treatment at a quaternary children's hospital from January 1, 2017 through December 31, 2020 who had plasma measurements of BOHB after DKA onset and whose DKA resolved by traditional laboratory criteria (venous pH (vpH) ≥ 7.3, serum bicarbonate (HCO ) ≥ 15 mmol/L, and/or anion gap (AG) ≤ 14 mmol/L).
METHODS
Associations between plasma BOHB and vpH, HCO , and AG were evaluated via scatterplots. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were used to evaluate BOHB cut-points to predict DKA resolution.
RESULTS
We analyzed 403 patients with 471 unique encounters. Plasma BOHB showed the most robust relationship with AG. The ROC curve comparing plasma BOHB to the accepted definition of DKA resolution, AG ≤14 mmol/L, had an AUC of 0.92. A BOHB value of <1.5 mmol/L had a sensitivity of 83% and specificity of 87%; this cut-point correctly classified 86% of the observations.
CONCLUSIONS
A plasma BOHB value of <1.5 mmol/L can be used to define resolution of DKA.
背景
糖尿病酮症酸中毒（DKA）是 1 型糖尿病（T1D）的一种常见且危及生命的并发症，其特征是相对或绝对胰岛素缺乏导致酮生成不受调节。DKA 的管理需要频繁进行生化监测。血浆 β-羟基丁酸（BOHB）尚未包含在 DKA 缓解的传统定义中。
目的
本研究旨在确定 BOHB 的切点水平，以定义接受静脉（IV）胰岛素治疗的 T1D 患者的 DKA 缓解情况。
受试者
我们从 2017 年 1 月 1 日至 2020 年 12 月 31 日，在一家四级儿童医院确定了接受 IV 胰岛素治疗 DKA 的 T1D 患者，这些患者在 DKA 发病后有血浆 BOHB 测量值，并且根据传统实验室标准（静脉 pH（vpH）≥7.3、血清碳酸氢盐（HCO ）≥15mmol/L 和/或阴离子间隙（AG）≤14mmol/L）缓解 DKA。
方法
通过散点图评估血浆 BOHB 与 vpH、HCO 和 AG 之间的相关性。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估 BOHB 切点以预测 DKA 缓解情况。
结果
我们分析了 403 名患者的 471 个独特就诊情况。血浆 BOHB 与 AG 之间的相关性最强。将血浆 BOHB 与公认的 DKA 缓解定义（AG≤14mmol/L）进行比较的 ROC 曲线的 AUC 为 0.92。BOHB 值<1.5mmol/L 的灵敏度为 83%，特异性为 87%；该切点正确分类了 86%的观察结果。
结论
血浆 BOHB 值<1.5mmol/L 可用于定义 DKA 的缓解。
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