Prognostic Role of Red Cell Distribution Width and Platelet-to-Lymphocyte Ratio in Patients with Diabetic Ketoacidosis

Abstract Background: Red cell distribution width (RDW) and platelet-to-lymphocyte ratio (PLR) may have a prognostic relationship with the severity of diabetic ketoacidosis (DKA). This study intended to explore any relationship of RDW as well as PLR values with the severity of DKA and its various outcomes. Methods: Adult patients with DKA were recruited from medicine emergency. RDW along with PLR were measured. The severity of illness was determined using the American diabetes association (ADA) criteria for DKA severity and quick Sequential Organ Failure Assessment (qSOFA) at admission. Patients were grouped into normal RDW (≤14)/high RDW (>14) and low PLR (≤181)/high PLR (>181) for analysis, taking their median values as cutoffs. Results: Fifty-six patients were enrolled, with a mean age of 41.4 ± 15.9 years. 53.6% of patients were female. 42.9% of patients had type I diabetes mellitus (DM). The mean duration of DM was 7.4 ± 6.3 years. Infections precipitated DKA in 48% of cases. DKA was mild in 27.3%, moderate in 33.9%, and severe in 39.3%. The mean HbA1c was 11 ± 2.7%, RDW was 14.89 ± 2.18, and PLR was 246.21 ± 189.03. Patients in the higher RDW group had higher mortality rate (32.1%) as compared to normal RDW (10.7%) ( P = 0.05). Patients in the higher PLR group also exhibited higher mortality, but without statistical significance ( P = 0.14). No significant difference was discernible in relation to qSOFA in either PLR groups ( P = 0.78) or RDW ( P = 0.42). Neither RDW ( P = 0.59) nor PLR ( P = 0.21) correlated with the severity of DKA. Conclusions: A higher RDW and PLR portray an elevated risk for incident mortality in patients with DKA. These inexpensive parameters may act as supportive biomarkers in predicting the prognosis and in-hospital outcomes in DKA.