Plasma high sensitivity C-reactive protein as a marker of severity in children with diabetic ketoacidosis

Abstract

Background: Diabetic ketoacidosis (DKA) is a metabolic crisis that can precipitate other life-threatening complications. Elevated plasma level of C-reactive protein (CRP) has been reported to be marker for endothelial cell dysfunction in uncomplicated, well-controlled, type 1 diabetes mellitus. Objective: This study was undertaken to identify the relation between Hs-CRP and the severity of DKA in children. Methods: This prospective study involved pediatric patients (age <15 years) who admitted to the ICU of Zagazig University Children2s Hospital with DKA during the period from May 2012 to May 2013. Blood samples were drawn at presentation before initial hydration and after resolution of DKA. Routine investigations were done. Serum IL-6 and Hs-CRP levels were measured. Results: Thirty patients were diagnosed as having DKA, 17 patients were males (56.7%). In most patients, DKA resolved in 24 to 48 hours. Mild DKA was diagnosed in 11 (36.7%) and moderate/severe DKA was present in 19 (63.4%) patients. Highly significant statistical difference was found between both groups as regard hs-CRP and IL6 (p value for both <0.001).As regard time factor, (at admission and after 48 hs) and its effect on hs-CRP and IL6, they did not significantly affected in mild DKA (p value for both < 0.05). Nevertheless, they showed highly significant statistical difference in moderate/severe DKA (p value for both <0.001). Hs-CRP was strongly associated with IL6 level and WBCs count in moderate /severe DKA. Conclusion: Hs-CRP is increased in moderate/severe DKA patients along with IL6 and leukocytes in absence of infection. This finding might clarify the role of hs-CRP in DKA crises as a marker of severity.

Keywords: Type I DM; Diabetic ketoacidosis; hs-CRP; IL6.