Diabetic ketoacidosis in adult patients with type 1 diabetes: the role of biomarkers and myocardial deformation parameters in the diagnosis of acute myocardial injury

Aim. To characterise the clinical-laboratory profile of adults with type 1 diabetes (T1D) hospitalised for diabetic ketoacidosis (DKA) and to assess echocardiographic parameters according to DKA severity and the presence of acute myocardial injury.

Material and methods. The single-center cross-sectional study included 160 patients aged 18 years and older with T1DM presenting with DKA. Based on DKA severity, patients were classified into mild (n=31), moderate (n=94), and severe (n=35) groups; additionally, patients were stratified by the presence or absence of AMI into AMI «positive» (n=90) and AMI «negative» (n=70) groups. Within the first 24 hours of hospitalisation, clinical evaluation, assessment of SOFA, APACHE II, and Glasgow Coma Scale scores, laboratory tests (glucose, HbA1c, high-sensitivity troponin I, N-terminal pro-brain natriuretic peptide, creatinine, urea, C-reactive protein, acid-base status parameters, lactate), as well as standard and speckle-tracking echocardiography were performed.

Results. In 72.0% of patients, DKA developed in previously diagnosed type 1 diabetes with poor treatment adherence, whereas in 28.0% it occurred at disease onset. Severe DKA was associated with longer diabetes duration (p=0.015), hemodynamic instability, higher APACHE II scores, lower Glasgow Coma Scale scores, and myocardial injury in all patients of this subgroup (p<0.001). Compared with injury-negative patients, the injury-positive group had longer diabetes duration (p=0.038), lower blood pressure, higher heart rate, more severe acidosis, and higher troponin I, NT-proBNP, creatinine, urea, glucose, and lactate levels (all p<0.001). Echocardiography showed higher left ventricular ejection fraction (p<0.001), larger indexed left atrial volume (p=0.007), less negative global longitudinal strain and right ventricular strain (both p<0.001), and lower global work efficiency (p<0.001), TAPSE (p=0.048), and peak atrial contraction strain (p=0.005). In the multivariable model, admission glucose (OR 1.08; 95% CI 1.00-1.16; p=0.04) and anion gap (OR 1.31; 95% CI 1.16-1.48; p<0.001) remained independently associated with myocardial injury.

Conclusion. Progression of DKA severity in adult patients with T1DM is accompanied by worsening metabolic and hemodynamic disturbances and an increased incidence of AMI. The presence of AMI is associated with alterations in myocardial deformation parameters and right heart function, despite preserved or increased left ventricular ejection fraction.

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