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Comparative Study
. 2024 Jul 30:68:e230183.
doi: 10.20945/2359-4292-2023-0183. eCollection 2024.

Characteristics and clinical relevance of leukocytic response in children with diabetic ketoacidosis - A comparative cohort study

Harish Kumar  1 , Bhanu Kiran Bhakhri  1 , Vernika Tyagi  1 , Nupur Singh  1 , Dharmendra Kumar Singh  1 , Ruchi Rai  2
Affiliations
Comparative Study

Characteristics and clinical relevance of leukocytic response in children with diabetic ketoacidosis - A comparative cohort study

Harish Kumar et al. Arch Endocrinol Metab. .

Abstract

Objective: Leukocytosis is often observed among children presenting with diabetic ketoacidosis (DKA). This study compares detailed parameters of leukocytosis in children presenting with DKA versus infection.

Subjects and methods: In this comparative cohort study, we collected data from two groups of children, one hospitalized with DKA and another with community-acquired pneumonia (CAP). The primary objective was to compare the neutrophil-to-lymphocyte ratio (NLR) between the groups. Total leukocyte count (TLC), absolute neutrophil count (ANC), platelet-to-lymphocyte ratio (PLR), and platelet-to-monocyte ratio (PMR) were also compared. The correlation of these hematological parameters with the clinical outcomes in the DKA group was also explored.

Results: Data from 35 children with DKA (mean age 7.4 years, 12 boys) and 40 children with CAP (mean age 7.9 years, 15 boys) were available for comparison. No significant NLR difference was observed between the DKA and CAP groups. Similarly, no significant difference was observed in TLC and ANC between the groups. However, significant differences between the DKA and CAP groups were observed regarding mean (standard deviation) PLR (108.26 [67.51] versus 166.60 [163.83], respectively, p = 0.01) and mean PMR (1,795.40 [4,307.00] versus 886.33 [1,726.41], p = 0.01). Among children with DKA, ANC and PMR correlated positively and hemoglobin level correlated negatively with unfavorable outcomes.

Conclusions: Specific parameters of leukocytosis (PLR and PMR) differed significantly in children with DKA versus CAP. Some widely available and inexpensive hematological parameters of inflammation (hemoglobin, ANC, and PMR) may predict outcomes in patients with DKA.

Keywords: Diabetic ketoacidosis; cerebral edema, type 1 diabetes mellitus; differential leukocyte count; leukocytosis.

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Conflict of interest statement

Disclosure: no potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1. Flow chart of details relevant to the study data collection.
Figure 2
Figure 2. Box plots of (A) neutrophil-to-lymphocyte ratio (NLR), (B) platelet-to-lymphocyte ratio (PLR), and (C) platelet-to-monocyte ratio (PMR) in children with diabetic ketoacidosis (“cases”, patterned bars) and children with community-acquired pneumonia (“controls”, white bars).
See this image and copyright information in PMC

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