RED CELL DISTRIBUTION WIDTH TO SERUM ALBUMIN RATIO AS NOVEL PROGNOSTIC BIOMARKER FOR DISEASE SEVERITY AND CLINICAL OUTCOME IN DIABETIC KETOACIDOSIS

Abstract

Diabetic Ketoacidosis (DKA) is a severe, acute complication of diabetes mellitus associated with hyperglycemia, ketosis and metabolic acidosis. During early detection of laboratory markers which are correlated to disease severity, this might help in prompt diagnosis and management. Red Cell Distribution Width (RDW) and serum albumin are becoming important markers of the severity of disease and systemic inflammation in a variety of clinical situations. Therefore, this study is conducted to find the relationship of serum albumin level with severity of diabetic ketoacidosis (DKA) and to find the association of Red Cell Distribution Width (RDW) with the severity of DKA. Also, the clinical relevance of the RDW-to-Albumin Ratio was evaluated in DKA patients. The study design was cross sectional analytical study, and the sample size was 100 patients of DKA. All the demographic parameters, RDW, serum albumin, ketone, blood pH, blood glucose and blood bicarbonate were recorded and analyzed in SPSS version 26. Severity of DKA was determined according to the blood pH parameters as mild, moderate and severe DKA. The differences between severity groups were evaluated by one-way ANOVA and relationships were assessed with blood pH by Pearson correlation analysis. A p value <0.05 was deemed significant. The study included 100 patient, 49.0% male, 51.0% female. Severe DKA was the most common category (64.0%). The mean serum albumin level was highest in mild DKA (1.70 ± 0.48 g/dL) but there was no statistically significant correlation between serum albumin level and the severity of DKA (F = 1.99, p = 0.142). The results showed that there was a significant difference in RDW among the different levels of severity of the DKA (F = 7.32, p = 0.001), suggesting that a relationship exists between RDW and DKA severity. However, there was no significant association between the RDW-to-Albumin Ratio and the severity of DKA (F = 2.20, p = 0.117). In addition, serum albumin, RDW and RDW-to-Albumin Ratio showed weak and non-significant relationships with blood pH. RDW was significantly related to the severity of DKA, indicating its potential as a readily available hematological marker for severity assessment. We did not find significant relationships between the severity of DKA and the levels of serum albumin or RDW-Albumin Ratio in our population.

Keywords: Diabetic Ketoacidosis, Red Cell Distribution Width, Serum Albumin, Blood pH, Severity Assessment