Clinical Characteristics of Concomitant Diabetic Ketoacidosis in Type 2 Diabetes Patients with Acute Pancreatitis

Figures & data

Table 1 Comparison of Demographic and Clinical Features on Admission of DKA Group and Non-DKA Group

	DKA (n=27)	Non-DKA (n=109)	Z/χ^2	P value
Sex			1.094	0.295
Male, n (%)	22 (81.5)	78 (71.6)
Female, n (%)	5 (18.5)	31 (28.4)
Age (years)	31(25–35)	50 (35–70)	−5.119	< 0.001
BMI (kg/m^2)	27.7 (24.4–32.5)	24.8 (23.3–27.6)	−2.823	0.005
Fever, n (%)	1 (3.7)	24 (22.0)	3.694	0.055
Abdominal pain, n (%)	23 (85.2)	103 (94.5)	1.556	0.212
Nausea and/or vomiting, n (%)	19 (70.4)	94 (86.2)	3.878	0.049
Not alert, n (%)	5 (18.5)	5 (4.6)	4.290	0.038
SBP (mmHg)	128 (116–151)	135 (120–147)	−0.589	0.556
DBP (mmHg)	78 (66–91)	78 (72–85)	−0.606	0.545

Abbreviations: DKA, diabetic ketoacidosis; BMI, body mass index; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Table 2 Comparison of Laboratory Findings of DKA Group and Non-DKA Group

	DKA (n=27)	Non-DKA (n=109)	Z	P value
Arterial PH	7.29 (7.19–7.32)	7.39 (7.37–7.42)	−7.930	<0.001
PaCO2 (mmHg)	20.5 (14.4–29.2)	36.3 (32.0–38.8)	−6.569	<0.001
PaO2 (mmHg)	97.0 (95.5–98.5)	91.1 (80.8–96.3)	−4.037	<0.001
HCO3^− (mmol/L)	11.1 (5.1–16.2)	23.2 (20.5–25.0)	−7.169	<0.001
Lac (mmol/L)	1.9 (1.2–2.6)	1.2 (0.9–1.7)	−3.183	0.001
AG (mmol/L)	20.8 (17.6–24.8)	13.3 (12.4–14.3)	−6.442	<0.001
WBC (×10^9/L)	15.9 (12.6–20.4)	12.2 (9.6–14.8)	−4.032	<0.001
HCT (%)	46.9 (43.4–50.1)	42.4 (39.3–45.1)	−4.327	<0.001
CRP (mg/L)	94.0 (12.5–200.6)	49.0 (14.9–102.0)	−1.896	0.058
ALT (U/L)	21.0 (13.5–30.0)	42.0 (21.0–118.0)	−3.724	<0.001
AST (U/L)	20.0 (13.5–24.5)	27.0 (18.0–134.0)	−3.291	0.001
ALB (g/L)	47.2 (42.1–49.6)	45.4 (41.4–47.8)	−1.489	0.136
GGT (U/L)	46.0 (19.0–62.5)	59.5 (31.5–244.3)	−2.687	0.007
ALP (U/L)	91.0 (70.0–124.0)	76.5 (59.8–118.3)	−1.580	0.114
Tbil (μmol/L)	15.7 (9.4–22.2)	19.9 (14.1–35.3)	−2.766	0.006
DBil (μmol/L)	5.5 (4.2–9.2)	8.2 (4.9–17.3)	−2.523	0.012
Glucose (mmol/L)	26.1 (21.8–35.6)	12.6 (9.6–17.6)	−7.204	<0.001
BUN (mmol/L)	6.6 (4.7–8.0)	5.0 (4.1–6.9)	−2.423	0.015
SCr (μmol/L)	73.0 (58.5–93.5)	66.0 (52.0–82.0)	−1.247	0.212
Ca^2+ (mmol/L)	2.2 (2.1–2.4)	2.3 (2.2–2.4)	−0.502	0.616
K^+ (mmol/L)	4.3 (3.9–5.1)	4.1 (3.8–4.4)	−2.477	0.013
Na^+ (mmol/L)	141.4 (137.5–143.0)	140.0 ± 4.6	−0.494	0.621
Serum osmolality (mOsm/kg)	320.3 (304.0–329.0)	301.7 ± 9.4	−4.689	<0.001
Serum amylase (U/L)	162.0 (99.0–689.0)	339.5 (99.0–1069.5)	−1.609	0.108
Triglyceride (mmol/L)	11.7 (4.7–27.3)	2.7 (1.2–22.6)	−3.134	0.002
Hypertriglyceridemia, n (%)	27 (100)	67 (61.5)	-	<0.001
Cholesterol (mmol/L)	9.9 (7.2–14.2)	5.9 (4.2–9.6)	−4.160	<0.001
HbA1C (%)	11.0 (9.0–12.1)	8.0 (7.1–9.5)	−5.388	<0.001

Abbreviations: DKA, diabetic ketoacidosis; PaCO₂, partial pressure of carbon dioxide; PaO₂, partial pressure of oxygen; Lac, lactate; HCO₃⁻, serum bicarbonate; AG, anion gap; WBC, white blood cell; HCT, hematocrit; CRP, C-reactive protein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALB, albumin; GGT, gamma-glutamyl transferase; ALP, alkaline phosphatase; Tbil, total bilirubin; DBil, direct bilirubin; BUN, blood urea nitrogen; SCr, serum creatinine; Ca²⁺, ionized calcium; K⁺, ionized potassium; Na⁺, ionized natrium; Cl⁻, ionized chloride; LDH, lactate dehydrogenase; HbA_1C, hemoglobin A₁c.

Table 3 Comparison of the Clinical Course of DKA Group and Non-DKA Group

	DKA (n=27)	Non-DKA (n=109)	Z/χ^2	P value
Intravenous insulin therapy, n (%)	22 (81.5)	15 (13.8)	46.749	<0.001
ICU admission, n (%)	10 (37.0)	6 (5.5)	20.727	<0.001
Total hospitalization (days)	15 (11–19)	11 (8–16)	−2.460	0.014
In-hospital mortality, n (%)	1 (3.7)	0 (0)	-	0.199

Abbreviations: DKA, diabetic ketoacidosis; ICU: intensive care unit.

Table 4 Comparison of the Etiologies of AP

	Total (n=136)	DKA (n=27)	Non-DKA (n=109)	χ^2	P value
Etiology, n (%)				23.176	<0.001
Gallstones	42 (30.9)	1 (3.7)	41 (37.6)
Alcohol abuse	27(19.9)	2 (7.4)	25 (22.9)
Hypertriglyceridemia	66 (48.5)	24 (88.9)	42 (38.5)
Idiopathic	1(0.7)	0 (0)	1 (0.9)

Abbreviations: AP, acute pancreatitis; DKA, diabetic ketoacidosis.

Table 5 Comparison of Risk Assessment Scores of DKA Group and Non-DKA Group

	DKA (n=27)	Non-DKA (n=109)	Z	P value
APACHE II	5 (2–8)	3 (2–6)	−1.879	0.060
Ranson criteria	3 (1–3)	2 (1–2.5)	−2.078	0.038
BISAP score	2 (1–2)	1 (1–2)	−0.990	0.322
Modified Marshall score	0	0	−0.158	0.874
Balthazar CT score, n (%)			−0.751	0.453
A	0 (0)	1 (0.9)
B	2 (7.4)	6 (5.5)
C	19 (70.4)	88 (80.7)
D	5 (18.5)	6 (5.5)
E	1 (3.7)	8 (7.3)
SOFA score	0 (0–1)	1 (0–2)	−1.673	0.094

Abbreviations: DKA, diabetic ketoacidosis; APACHE II, Acute Physiology and Chronic Health Evaluation II; BISAP score, Bedside Index for Severity in Acute Pancreatitis; SOFA score, Sequential Organ Failure Assessment Score.

Table 6 AUC for Blood Glucose Identifying Concomitant DKA in T2DM Patients with AP

	AUC	SD	P value	95% CI
Blood glucose	0.949	0.020	<0.001	0.909–0.988

Abbreviations: AP, acute pancreatitis; DKA, diabetic ketoacidosis; AUC, surface area under the curve; SD, standard deviation; 95% CI, 95% confidence interval.

Table 7 Cut-off Value of Blood Glucose for Identifying Concomitant DKA in T2DM Patients with AP

	Cut-off (mmol/L)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)
Blood glucose	21.75	81.5	94.5	78.6	95.4	91.9

Abbreviations: AP, acute pancreatitis; DKA, diabetic ketoacidosis; PPV, positive predictive value; NPV, negative predictive value.

Figure 1 ROC curve analysis for sensitivity and specificity of blood glucose for diagnosis of concomitant DKA. ROC curve, receiver operating characteristics curve. The surface area under the curve for blood glucose identifying concomitant DKA was 0.949 (95% CI, 0.909–0.988).