Hu Yi-Jia, Qiu Shu-Xiao, Zhang Jian-Nan, Lai Qi-Qi, Lin Yi-Lu, Liu Lin-Qiong, Wu Di, Liu Hui-Ying, Meng Huan, Xu Jia-Xi, Zhang Jia-Ning, Liu Bo-Wen, Gao Yan, Kang Kai, Gao Yang
Pediatric Surgery Clinic, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China.
Department of Emergency, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China.
Sci Rep. 2025 Jan 23;15(1):3012. doi: 10.1038/s41598-024-84054-3.
This study aimed to investigate whether lymphocyte-C-reactive protein ratio (LCR) upon admission can predict disease progression and intensive care unit (ICU) admission in adult patients with diabetic ketoacidosis (DKA). A single-center retrospective study was conducted, including adult DKA patients admitted to the First Affiliated Hospital of Harbin Medical University between March 2018 and March 2023. Multiple demographic and clinical data were collected from the medical records upon admission and during hospitalization. Subsequently, sequential organ failure assessment (SOFA) score and LCR were calculated based on relevant clinical parameters within 24 h of admission. These indicators were compared among different disease severity groups, and factors related to severe DKA, concurrent acute kidney injury (AKI), and ICU admission were further analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity, specificity, area under the ROC curve (AUC), and cut-off value of LCR. A total of 271 adult DKA patients were enrolled and categorized into three groups: mild group (n = 42), moderate group (n = 64), and severe group (n = 165). Significant differences in demographic and clinical data were observed among these groups. Glasgow coma scale (GCS) score, LCR, pH, and bicarbonate (HCO) were identified as protective factors for severe DKA. Conversely, SOFA score, neutrophil count (NEUT), serum creatinine (SCr), and glucose (GLU) were risk factors for concurrent AKI. Concurrent AKI and SOFA score were risk factors for ICU admission, while pH was a protective factor. The areas under the ROC curve (AUC) of LCR to classify adult DKA patients into mild group, severe group, and ICU admission were 0.679, 0.718, and 0.621, respectively, with cut-off value of 212.80, 96.16, and 63.35, sensitivity of 54.8%, 76.4%, and 78.9%, and specificity of 76.0%, 62.4%, and 46.3%. LCR upon admission provides great potential to predict disease progression and ICU admission in adult patients with DKA.
本研究旨在探讨成人糖尿病酮症酸中毒（DKA）患者入院时的淋巴细胞- C反应蛋白比值（LCR）是否能够预测疾病进展及入住重症监护病房（ICU）的情况。开展了一项单中心回顾性研究，纳入了2018年3月至2023年3月期间在哈尔滨医科大学附属第一医院住院的成年DKA患者。收集了患者入院时及住院期间病历中的多项人口统计学和临床数据。随后，根据入院后24小时内的相关临床参数计算序贯器官衰竭评估（SOFA）评分和LCR。比较了不同疾病严重程度组之间的这些指标，并进一步分析了与重度DKA、并发急性肾损伤（AKI）及入住ICU相关的因素。进行了受试者操作特征（ROC）曲线分析，以确定LCR的敏感性、特异性、ROC曲线下面积（AUC）及临界值。共纳入271例成年DKA患者，并将其分为三组：轻度组（n = 42）、中度组（n = 64）和重度组（n = 165）。这些组之间在人口统计学和临床数据方面存在显著差异。格拉斯哥昏迷量表（GCS）评分、LCR、pH值和碳酸氢根（HCO）被确定为重度DKA的保护因素。相反，SOFA评分、中性粒细胞计数（NEUT）、血清肌酐（SCr）和血糖（GLU）是并发AKI的危险因素。并发AKI和SOFA评分是入住ICU的危险因素，而pH值是保护因素。将成年DKA患者分为轻度组、重度组及预测入住ICU时，LCR的ROC曲线下面积（AUC）分别为0.679、0.718和0.621，临界值分别为212.80、96.16和63.35，敏感性分别为54.8%、76.4%和78.9%，特异性分别为76.0%、62.4%和46.3%。入院时的LCR在预测成年DKA患者疾病进展及入住ICU方面具有很大潜力。
