Interleukin-6 and C-reactive protein as early markers of sepsis in patients with diabetic ketoacidosis or hyperosmosis

Aims/hypothesis. An early diagnosis of sepsis in patients with diabetic ket oacidosis and hyperosmolar non-ketotic coma is crucial and could save lives . We studied serum C-reactive protein and interleukin-6 to find out how use ful these might be for identifying sepsis. Methods. Sixty one diabetic patients with ketoacidosis or hyperosmolar non- ketotic coma were enrolled. Patients with signs and symptoms of systemic in flammatory response syndrome were identified. Acute-phase reactants, includ ing C-reactive protein and interleukin-6, the main cytokine responsible for the induction of acute-phase proteins, were measured on admission and when patients had clinically improved and were euglycaemic. Results. A total of 49 out of 61 patients with diabetic ketoacidosis or hyp erosmosis had signs of systemic inflammatory response syndrome. Another 27 patients had systemic inflammatory response syndrome and no signs of infect ion and 22 patients had systemic inflammatory response syndrome due to prov en infection. We detected a significant increase in serum C-reactive protei n and interleukin-6 values in patients infected compared with patients not infected with systemic inflammatory response syndrome SIRS. Patients who fi nally died had much higher levels of these proteins, while there was a prom pt reduction of serum C-reactive protein and interleukin-6 early during rem ission. Conclusion/interpretation. Diabetic ketoacidosis and hyperosmolar non-ketot ic coma can often cause a clinical syndrome resembling systemic inflammator y response syndrome. Determination of serum C-reactive protein and interleu kin-6 levels is a useful way of excluding an underlying infection early on as well as confirming and monitoring sepsis.