Correlation between leukocytosis and infection in patients with diabetic ketoacidosis

Abstract

Abstract Background Diabetic Ketoacidosis, a fatal complication of diabetes, presents in patients with type 1 and type 2 diabetes mellitus. Psychological stress or any acute medical condition, such as infections and surgeries, can trigger and alleviate diabetic ketoacidosis. Like infections, diabetic ketoacidosis can result in leukocytosis, making it harder to distinguish between the two conditions, resulting in the overuse of antimicrobial agents to blindly treat infections, and increasing the rate of antimicrobial resistance, a global threat to humanity. Methods A retrospective cross-sectional study was conducted on the correlation between infection and leukocytosis in patients referring to Imam Khomeini Hospital Complex, Tehran, Iran, from September 2018 to September 2022. Comorbidities, clinical findings at admission, acidosis severity, hospitalization duration, laboratory data, and radiologic findings were retrieved using the Hospital Information System and then compared and analyzed. Results Of the 129 evaluated patients, 84 showed leukocytosis, while 45 did not. The mean age of participants was 38.17 ± 21.30 years. The total population included 52 males and 77 females; 92 were diagnosed with type 1 diabetes, and 37 had type 2 diabetes, with a mean duration of diabetes of 8.07 ± 6.99. We evaluated the correlation between leukocytosis due to infection in patients with diabetic ketoacidosis and their age, sex, diabetes type, and duration, PH levels, hospitalization duration, erythrocyte sedimentation rate and C-reactive protein levels, chest X-ray findings, blood and urine culture results, patients' prognosis, and presence of an infectious process in general. We found no correlation between leukocytosis and sex, diabetes type, PH levels, and blood cultures. However, there were significant correlations between leukocytosis and infection presence, urine cultures, radiologic findings, patients' age, diabetes and hospitalization duration, and ESR and CRP levels. We also found a white blood cell count threshold of 14.96 as a sign of infection in patients with DKA. Conclusion Our findings suggested that a total WBC count of, 14000/mm3 or higher can indicate the presence of infection in patients with DKA, which could indicate the start of antibiotic therapy in such patients. Trial registration Not applicable. This study is not a clinical trial.