The Clinical Value of Bloodβ-hydroxybutyric Acid and Urine Ketone in the Diagnosis of Diabetic Ketosis / 昆明医科大学学报

Objective To investigate the clinical value of bloodβ-hydroxybutyric acid and urine ketone in the diagnosis of diabetic ketosis. Methods One hundred and fifteen patients with non-ketosis diabetics (NDK group), 85 patients with diabetic ketosis (DK group) and 105 healthy people (control group) were enrolled in Chengmai People's Hospital from May 2012 to May 2014. Blood β-hydroxybutyric acid, urine ketone and blood glucose were detected; the correlation index of blood β-hydroxybutyric acid, urine ketone and blood glucose in NDK group and DK group were analyzed. The receiver operating characteristic curve (ROC) was performed in determining the diagnostic value of bloodβ-hydroxybutyric acid for diabetic ketosis. Results The level of bloodβ-hydroxybutyric acid, positive rate of bloodβ-hydroxybutyric acid, urine ketone and level of blood glucose in DK group were higher than those in NDK group and NC group (P<0.01) . Blood β-hydroxybutyric acid was positively correlated with urine ketone and blood glucose (r=0.552,P=0.000;r=0.405,P=0.010) . When urine ketone was used as diagnostic standard, the area under curve of bloodβ-hydroxybutyric acid was 0.839, the best cutoff value ofβ-hydroxybutyric acid was 0.64 mmol/L with the sensitivity was 81.6%and specificity was 89.2%. Conclusions Examinations of bloodβ-hydroxybutyric acid and urine ketone have great significance for the diagnosis of diabetic ketosis. The co-monitoring of blood β-hydroxybutyric acid and urine ketone can reduce the rates of missed diagnosis and misdiagnosis. The best cutoff value of β-hydroxybutyric acid to diagnose diabetic ketosis was 0.64 mmol/L.

Evaluation of the Clinical Significance of Ketonuria

BACKGROUND: Urine ketone test is commonly used to screen for diabetic ketoacidosis (DKA). Ketonuria also develops in patients with disease conditions other than DKA. However, the prevalence of DKA in patients with ketonuria is not known. We investigated the prevalence of ketonuria and characteristics of patients with ketonuria and estimated the prevalence of DKA among them to study the clinical significance of ketonuria as an indicator of DKA. METHODS: We studied 1,314 adult and 1,027 pediatric patients who underwent urinalysis. The prevalence of ketonuria in the different groups of patients, classified according to the types of their visits to the institution, was investigated, and the relationships between ketonuria and albuminuria, glycosuria, and bilirubinuria were evaluated. RESULTS: The overall prevalence of ketonuria was 9.1%. The prevalences of ketonuria in adult and pediatric patients were 4.3% and 15.2%, respectively. The prevalences of ketonuria were the highest in the adult (9.7%) and pediatric (28%) patients in the group that had visited the emergency department. Among patients with ketonuria, 7% adult and 3.8% pediatric patients showed glycosuria. CONCLUSIONS: This study showed that the prevalence of DKA in patients with ketonuria, defined as the simultaneous presence of ketone bodies and glucose in urine, was only 7%. Therefore, we concluded that ketonuria might be clinically significant as an indicator of acute or severe disease status rather than of DKA.

Ketonuria after Fasting may be Related to the Metabolic Superiority

Obese individuals are less able to oxidize fat than non-obese individuals. Caloric reduction or fasting can detect ketonuria. We investigated the differences of metabolic parameters in the presence of ketonuria after a minimum 8 hr fast in a cross-sectional analysis of 16,523 Koreans (6,512 women and 10,011 men). The relationship between the presence of ketonuria of all subjects and prevalence of obesity, central obesity, metabolic syndrome, and obesity-related metabolic parameters were assessed. The ketonuria group had lower prevalence of obesity, central obesity, and metabolic syndrome than the non-ketonuria group. In addition, all metabolic parameters (including body weight, waist circumference, blood glucose, high-density lipoprotein, triglyceride, blood pressure, and insulin) were favorable in the ketonuria group than in the non-ketonuria group, even after adjustment for age, tobacco use, and alcohol consumption. The odds ratios of having obesity (odds ratio [OR]=1.427 in women, OR=1.582 in men, P<0.05), central obesity (OR=1.675 in women, OR=1.889 in men, P<0.05), and metabolic syndrome (OR=3.505 in women, OR=1.356 in men, P<0.05) were increased in the non-ketonuria group compared to the ketonuria group. The presence of ketonuria after at least an 8 hr fast may be indicative of metabolic superiority.