Int J Med Sci 2013; 10(6):758-765. doi:10.7150/ijms.6155 This issue
1. School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China;
2. Department of Endocrinology, the Affiliated Huai'an Hospital of Xuzhou Medical College, Huai'an, Jiangsu 223002, China;
3. Department of Critical Care Medicine, the Affiliated Yixing People's Hospital of Jiangsu University, Yixing, Jiangsu 214200, China;
4. Department of Clinical Laboratory, the Affiliated Huai'an Hospital of Xuzhou Medical College, Huai'an, Jiangsu 223002, China.
* Co-first authors.
Objective: To determine the correlation between differential leukocyte counts and hyperglycemic emergencies.
Methods: Fifty patients with diabetic ketoacidosis (DKA), 50 patients with diabetic ketosis (DK), 50 non-DK diabetic patients with stable glycemic control, and 50 normal controls were enrolled. Their total and differential leukocyte counts were measured and evaluated at admission and after treatment.
Results: The patients with DKA and DK had higher plasma glucose levels (20.84±6.73 mmol/L, 15.55±2.6 mmol/L, respectively) and more median leukocytes (13325/mm3 and 6595/mm3, respectively) and median neutrophils (11124 /mm3 and 4125/mm3, respectively) but fewer median eosinophils (28/mm3 and 72/mm3, respectively) compared to non-DK and control groups (all p < 0.05). Acute infection increased the elevating extent. The median leukocyte counts in DK and non-DK patients (6595/mm3 and 6008/mm3, respectively) were within the normal range. The counts of total leukocytes and neutrophils were significantly higher but eosinophils lower in severe DKA cases than in mild/moderate cases (p < 0.05). When the DKA and DK and infection resolved, total leukocytes and neutrophils fell, but eosinophils increased. The counts of total leukocytes, neutrophils, and monocytes were negatively correlated with arterial pH levels (r = -0.515, r = -0.510, r = -0.517, all p < 0.001, respectively) and positively correlated with plasma glucose levels (r = 0.722, r = 0.733, r = 0.632, all p < 0.05, respectively) in DKA patients. The arterial pH level was the most significant factor affecting total leukocytes in DKA (β = 0.467, p = 0.003). The diagnosis analysis showed that higher total leukocyte and neutrophil counts and lower eosinophil counts had a significant ability to reflect the presence of hyperglycemic emergencies.
Conclusion: More total leukocytes and neutrophils but fewer eosinophils was significantly correlated with DKA and DK. Leukocyte counts can add valuable information to reflect the presence of hyperglycemic crisis and acute infection.
Keywords: Diabetic ketoacidosis, Diabetic ketosis, Leukocytes counts.