Sepsis screening tools for predicting infection triggers and outcomes in diabetic ketoacidosis

Background: An early prediction of infection is challenging in diabetic ketoacidosis (DKA). Methods: This prospective cohort study aimed to assess effectiveness of various sepsis screening tools in predicting infections and prognosis in DKA. Results: Among 141 cases, infection (44.0%) was the commonest precipitating factor. A Sequential Organ Failure Assessment score >= 4 showed high specificity (82.28%) and high positive likelihood ratio (2.64) but limited sensitivity (46.77%). Conversely, Systemic Inflammatory Response Syndrome >= 2 exhibited good sensitivity (95.16%) but a high false-positive rate (84.28%). National Early Warning Score >= 7 and Quick Sequential Organ Failure Assessment >= 2 had low sensitivity and specificity. These sepsis tools also demonstrated low prognostic accuracy for mortality. Conclusion: Sepsis screening tools have limited predictive accuracy for infections and mortality in DKA. Various clinical tools, including the Sequential Organ Failure Assessment score, Quick Sequential Organ Failure Assessment score, Systemic Inflammatory Response Syndrome criteria and the National Early Warning Score, are used to identify serious infections. This study examined the effectiveness of these tools in patients with diabetic ketoacidosis (DKA), a serious diabetes complication. The study involved 141 patients from north India, and nearly half of them had infections such as pneumonia and urinary tract infections. The researchers found that these tools were not highly effective in identifying infections or predicting deaths among DKA patients at the time of hospital admission. The study suggests that doctors need better ways to diagnose infections in DKA, including more thorough clinical evaluations and advanced tests.