The ratio of red cell distribution width to mean corpuscular volume in patients with diabetic ketoacidosis.

BACKGROUND: The relationship between erythrocyte parameters and diabetic ketoacidosis (DKA) remains uncertain. This study aimed to investigate the potential role of erythrocyte indices in type 1 diabetes (T1D) patients with DKA.

METHODS: This study included 48 patients with T1D, 26 patients with DKA, and 30 age- and gender-matched controls. Erythrocyte parameters were measured and evaluated at the time of admission and after treatment.

RESULTS: Data were analyzed by One-Way ANOVA Tukey analysis with SPSS software. The DKA patients had higher levels of plasma glucose (28.87 +/- 9.01 mmol/L), HbA1c (13.08 +/- 3.10%), osmotic pressure (332.11 +/- 11.67 mosm/L), red cell distribution width (RDW, 41.24 +/- 3.08 fL), and the RDW to mean corpuscular volume (MCV) ratio (47.50 +/- 3.70%) compared to non-DKA cases and controls (all p < 0.05). Pearson's correlation test showed that osmolality was positively correlated with plasma glucose (r = 0.699, p < 0.001) and negatively correlated with mean corpuscular hemoglobin concentration (MCHC) (r = -0.409, p = 0.049). Receiver operating characteristic curve analyses demonstrated that the areas under the curves were 0.924 for the RDW/MCV ratio and 0.802 for RDW in the ability of reflecting DKA (z = 2.086, p = 0.0369). A logistic regression revealed that the RDW/MCV ratio can act as a robust risk marker for the presence of DKA (OR = 1.548, p = 0.0360, 95% CI: 1.029 - 2.330). The RDW returned to normal, and plasma glucose levels and metabolic acidosis were well controlled following treatment.

CONCLUSIONS: The RDW and the RDW/MCV ratio were significantly correlated with DKA. The RDW/MCV ratio can act as a robust biomarker that is more sensitive than RDW in reflecting the presence of DKA.