title: Platelet-to-Lymphocyte Ratio: A Novel Prognostic Factor for Prediction of 90-day Outcomes in Critically Ill Patients With Diabetic Ketoacidosis.
abstract: Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus and the novel systemic inflammation marker platelet-to-lymphocyte ratio (PLR) may be associated with clinical outcome in patients with DKA. This study aimed to investigate the utility of PLR in predicting 90-day clinical outcomes in patients with DKA. Patient data exacted from the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database was analyzed. A cutoff value for PLR of 267.67 was determined using Youden index (P < 0.05) and used to categorize subjects into a high PLR group and a low PLR group. The hazard ratios (HRs) and 95% confidence intervals (CIs) for DKA were calculated across PLR. Clinical outcomes in our study were defined as intensive care unit (ICU) 90-day readmission and all-cause mortality. A total of 278 ICU admissions were enrolled and stratified by cutoff value of PLR. The incidence of readmission and mortality was 17.8% in the high PLR group, significantly higher than 7.4% in the low PLR group. In the multivariable model, after adjusting for known confounding variables including clinical parameters, comorbidities, laboratory parameters, the HRs for DKA were 2.573 (95% CI 1.239-5.345; P = 0.011), 2.648 (95% CI 1.269-5.527; P = 0.009), and 2.650 (95% CI 1.114-6.306; P = 0.028), respectively. The Kaplan-Meier survival curve showed that a high PLR level was associated with a higher risk for 90-day outcomes in patients with DKA. The authors report that higher PLR presents a higher risk for 90-day incidence of readmission and mortality in patients with DKA. It appears to be a novel independent predictor of 90-day outcomes in critically ill DKA patients in ICU units.
authors.affiliation: From the Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University (W-YL, C-CF, F-XS); School of the First Clinical Medical Sciences (S-GL, L-RW, G-QZ); Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University (L-RW, Y-QL, G-QZ, M-HZ); Renji School of Wenzhou Medical University, Wenzhou, China (Y-QL); Global Medicines Development, AstraZeneca R&D, Loughborough, United Kingdom (MB); Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua (ZZ); and Institute of Hepatology, Wenzhou Medical University, Wenzhou, China (M-HZ).
authors.forename: Wen-Yue
authors.initials: WY
authors.lastname: Liu
authors.forename: Shi-Gang
authors.initials: SG
authors.lastname: Lin
authors.forename: Li-Ren
authors.initials: LR
authors.lastname: Wang
authors.forename: Chen-Chen
authors.initials: CC
authors.lastname: Fang
authors.forename: Yi-Qian
authors.initials: YQ
authors.lastname: Lin
authors.forename: Martin
authors.initials: M
authors.lastname: Braddock
authors.forename: Gui-Qi
authors.initials: GQ
authors.lastname: Zhu
authors.forename: Zhongheng
authors.initials: Z
authors.lastname: Zhang
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
authors.forename: Fei-Xia
authors.initials: FX
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D016883:Diabetic Ketoacidosis / Q000097:blood* / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
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