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Plasma C-Reactive Protein Levels in Severe Diabetic Ketoacidosis

Address correspondence to William H. Hoffman, M.D., Section of Pediatric Endocrinology, BG-1012, Medical College of Georgia, Augusta, GA 30912, USA; tel 706 721 4158; fax 706 721 1484; e-mail: whoffman{at}mail.mcg.edu.

Elevated plasma levels of C-reactive protein (CRP) and IL-6 have been reported to be sensitive indicators of infection in adults with diabetic ketoacidosis (DKA). However, both CRP and the pro-inflammatory cytokines, which regulate CRP, can be elevated without infection. Our hypothesis was that CRP is increased in young patients with severe DKA, even in the absence of an infection, and may serve as a marker for systemic inflammatory response syndrome (SIRS). In 7 patients with severe DKA without infection, we measured plasma CRP, IL-6, IL-1ß and TNF- levels prior to, during, and following correction of DKA. CRP was significantly but transiently elevated in 4 of the patients prior to or during treatment of DKA, compared to their baseline values (96 hr after correction of DKA). There were significant positive relationships between CRP and both IL-6 and IL-1ß prior to treatment (p <0.05); between CRP and IL-6, IL-1ß, and TNF- at 6 hr (p <0.05); and between CRP and IL-1ß at 24 hr (p <0.05). The results support the hypothesis that CRP is increased in some patients by severe DKA and its treatment, and that DKA can be associated with a non-infectious form of SIRS.

Keywords: C-reactive protein, diabetic ketoacidosis, cytokines, systemic inflammatory response syndrome

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