Procalcitonin, cytokine and NOx in diabetic ketoacidosis

Introduction

Procalcitonin (PCT), cytokine and NOx concentrations are different in patients with systemic inflammatory response syndrome (SIRS) and sepsis. Diabetic ketoacidosis (DKA) is frequently accompanied by SIRS, and inflammatory cytokines can increase in the absence of infection. The aim of this study was to determine PCT, IL-6, IL-8, IL-10 and NOx between patients with SIRS and sepsis in DKA patients.

Methods

Patients with DKA admitted to Dr Cipto Mangunkusumo Hospital Jakarta, between 1998 and 1999, were retrospectively reviewed. Plasma IL-6, IL-8, and IL-10 levels were measured by commercially available kits based on ELISA. Nitrate and nitrite (NOx) levels were measured by Griess reagent. PCT concentrations were measured by the immunoluminometric method (PCT LIA; BRAHMS Aktiengesellschaft GmbH, Germany).

Results

Patients characteristic are presented in Table 1. Clinical characteristics were similar in both groups. PCT and IL-6 on admission were higher in septic groups compared with SIRS groups. The mean of PCT was 0.1 ± 0.1 in SIRS groups and 26.5 ± 25.9 in sepsis groups (P < 0.05). IL-6 in SIRS groups ranged from 10 to 38 (median 24.7) and in sepsis groups ranged from 15.9 to 562.1 (median 46.2, P < 0.05). Serum IL-8, IL-10 and NOx did not differ in both groups.

Table 1 Characteristics of 22 patients with DKA

Conclusion

Most cases of DKA had signs of SIRS. PCT and IL-6 are a useful marker to differentiate between SIRS and sepsis in ketoacidosis patients.