Monitoring of hypertension, pyuria and neutrophil-to-lymphocyte ratio in DKA patients

Shaheen, Ashraf Mohamed; Ramadan, Hanaa; Fayed, Sahar Mohamed; Zaki, Zaki Mahrous

doi:10.21608/bmfj.2025.338292.2260

Monitoring of hypertension, pyuria and neutrophil-to-lymphocyte ratio in DKA patients

Document Type : Original Article

Authors

¹ Professor of Pediatrics and Neonatology Faculty of Medicine - Benha University

² Lecturer of Pediatrics and Neonatology Faculty of Medicine - Benha University

³ Professor of Clinical Pathology Faculty of Medicine - Benha University

⁴ Faculty of Medicine - Tanta University )M.B.B.CH(

10.21608/bmfj.2025.338292.2260

Abstract

Background: Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration. It is a life-threatening complication of diabetes, usually seen in patients with type-1 diabetes mellitus. This study aimed to assess hypertension, pyuria and neutrophil to lymphocyte ratio (NLR) in DKA patients and their relation to severity, complications and mortality. Methods: This cross sectional study included 100 children with DKA. All the participants were subjected to full history taking, clinical examination and laboratory investigations. Results: Most cases had severe DKA (41%), 32% had moderate DKA and 27% had mild DKA. Heart rate, respiratory rate, systolic and diastolic blood pressure were significantly higher in severe DKA group compared to mild and moderate groups. Patients with severe DKA had statistically higher HbA1c, WBCs, neutrophils and NLR, and statistically lower lymphocytes compared to mild and moderate groups. Children with severe DKA group had statistically significant higher frequency of pyuria, complication, and longer duration of hospital stay compared to mild and moderate groups. ROC analysis was done to assess the performance of NLR to detect severe DKA; at a cutoff point > 5.5, the sensitivity was 68.5% and specificity was 94.9%, p < 0.001. Conclusion: Hypertension and pyuria was frequent in children with DKA and were associated with severe DKA. NLR was statistically higher in severe DKA, in patients with hypertension and in patients with pyuria. NLR is an easy, cheap and quick test which showed a good predictive poor of cases with severe DKA.

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