Serological prediction of infections in diabetic patients with diabetes ketoacidosis in Penang, Malaysia

Purpose: To determine the prevalence and predictors of infection in diabetic patients with diabetic ketoacidosis (DKA) who were ≥18 years. Methods: A retrospective cohort design was adopted for this study. A total of 967 diabetes ketoacidosis patients from Hospital Pulau Pinang for the 3-year period, Jan 2008 - Dec 2010, were identified and enrolled. The data were analysed, as appropriate, by Student t-test and ANOVA for the normally distributed data, Mann-Whitney U rank sum and Kruskall-Wallis tests for continuous, non-nominal data and Chi-square for dichotomous variables. Odd Ratios with 95% confidence interval (CI) were also presented where applicable. Results: Of the total diabetes ketoacidosis patients, 112 (11.6 %) were cases without infection, 679 (70.2 %) bacterial infection cases and 176 (18.2 %) presumed viral infection cases. The mean white blood count (WBC) for all the patients was 18,177 ± 9,431 while 721 (74.6 %) had leukocytosis, defined by WBC ≥ 15,000/mm ³. WBC differential, leukocytosis, as well as sex and body temperature were not significant predictors (p >.05) of bacterial infection. There was, however, a significant difference (p <.05) in terms of age within groups, as those > 57 years showed a higher rate of infection. Conclusion: The infection rate in elderly patients with DKA is high and a majority of them lack clinical evidence. Age has a significant effect on the rate and prediction of infection. Leukocytosis is commonly found but severe ketoacidosis was more likely than the presence of infection.