CRP valid for predicting bacteremia and morality in hyperglycemic emergencies, reveals multicenter study

The study found a higher mortality rate in patients with bacteremia than in patients without it. C-reactive protein (CRP), rather than procalcitonin (PCT), may be valid for diagnosing bacteremia in hyperglycemic emergencies.

"Among individuals hospitalized with diabetic ketoacidosis and HHS, the mortality rate of patients with bacteremia was higher than that of patients without it," the researchers reported in Diabetes Research and Clinical Practice. "C-reactive protein outshone procalcitonin in diagnosing bacteremia (AUC of 0.85 vs. 0.76)." Age, hypotension, level of consciousness, and elevated CRP levels were identified as key predictors for bacteremia risk.

Kyosuke Takahashi, Jichi Medical University Saitama Medical Center, Saitama-city, Saitama, Japan, and colleagues investigated infection characteristics and the utility of inflammatory markers in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome.

For this purpose, the researchers conducted a multicenter, retrospective observational study in 21 acute-care hospitals in Japan. The study included adult hospitalized patients with DKA and HHS.

They analyzed the diagnostic accuracy of markers, including CRP and PCT for bacteremia. Multiple regression models were created for estimating bacteremia risk factors.

The researchers reported the following findings:

· 771 patients, including 545 patients with DKA and 226 patients with HHS, were analyzed. The mean age was 58.2 years. Of these, 70 tested positive for blood culture.

· The mortality rates of those with and without bacteremia were 14 % and 3.3 %.

· The area under the curve (AUC) of CRP and PCT for diagnosis of bacteremia was 0.85 and 0.76, respectively.

· Logistic regression models identified altered levels of consciousness, older age, hypotension, and higher CRP as risk factors for bacteremia.

While the study's retrospective nature poses inherent limitations, the insights gleaned from this multicenter analysis provide a foundation for future prospective investigations aimed at refining infection management strategies in patients with DKA and HHS.

As healthcare providers grapple with the complex interplay between metabolic derangements and infectious complications in DKA and HHS, studies like this serve as vital stepping stones toward enhanced diagnostic precision, tailored therapeutic interventions, and improved clinical outcomes for affected individuals.

Reference:

Takahashi, K., Uenishi, N., Sanui, M., Uchino, S., Yonezawa, N., Takei, T., Nishioka, N., Kobayashi, H., Otaka, S., Yamamoto, K., Yasuda, H., Kosaka, S., Tokunaga, H., Fujiwara, N., Kondo, T., Ishida, T., Komatsu, T., Endo, K., Moriyama, T., . . . Sasabuchi, Y. (2024). Epidemiology, microbiology, and diagnosis of infection in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: A multicenter retrospective observational study. Diabetes Research and Clinical Practice, 111713. https://doi.org/10.1016/j.diabres.2024.111713