Analysis on association of serum β-HB and HbA1c with occurrence of cognitive dysfunction in diabetic ketoacidosis pediatric patients complicated with cerebral edema

MI Yanru; ZHANG Liguang; FAN Aihong

doi:10.3969/j.issn.1674-3806.2025.07.15

Abstract：Objective To explore the association of serum beta-hydroxybutyrate(β-HB)and glycated hemoglobin(HbA1c)with occurrence of cognitive dysfunction in diabetic ketoacidosis(DKA)pediatric patients complicated with cerebral edema.Methods A total of 148 DKA pediatric patients complicated with cerebral edema who were admitted to Tangshan Central Hospital from March 2020 to March 2023 were recruited.After the pediatric patients were admitted to the hospital for treatment and their vital signs were stable,the cognitive function of the pediatric patients was evaluated by using Wechsler Intelligence Scale for Children,Fourth Edition(WISC-Ⅳ),and the pediatric patients were divided into cognitive dysfunction group(WISC-Ⅳ scores＜80 points,26 patients)and control group(WISC-Ⅳ scores ≥80 points,122 patients)according to the evaluation results.The levels of serum β-HB and HbA1c,and the other clinical data were compared between the two groups.The correlation of serum β-HB and HbA1c with WISC-Ⅳ scores were analyzed by using Pearson correlation.Multivariate logistic regression was used to analyze the risk factors of cognitive dysfunction in the DKA pediatric patients complicated with cerebral edema.The efficacy of serum β-H B and HbA1c levels in predicting cognitive dysfunction in the DKA pediatric patients complicated with cerebral edema was evaluated by using receiver operating characteristic(ROC)curve.Results Compared with those in the control group,the levels of fasting plasma glucose(FPG),lactic acid(Lac),total cholesterol(TC),HbA1c and β-HB in the cognitive dysfunction group were increased,while the levels of blood sodium and blood pH in the cognitive dysfunction group were decreased,with statistically significant differences between the two groups(P＜0.05).The results of Pearson correlation analysis showed that the levels of serum β-HB and HbA1c were negatively correlated with the WISC-Ⅳ scores(r=-0.634,P＜0.001;r=-0.590,P＜0.001).The results of multivariate logistic regression analysis showed that higher levels of β-Hb[OR(95％CI)=2.119(1.090-4.118)]and HbA1c[OR(95％CI)=2.423(1.083-5.423)]were independent risk factors for cognitive dysfunction in the pediatric patients(P＜0.05),while higher blood sodium level[OR(95％CI)=0.590(0.363-0.960)]was an independent protective factor for inhibiting cognitive dysfunction(P＜0.05).The results of ROC curve analysis showed that serumβ-Hb and HbA1c could effectively predict cognitive dysfunction in the DKA pediatric patients complicated with cerebral edema(P＜0.05),and the predicting efficacy of the combined detection of the two indicators[AUC(95％CI)=0.930(0.867-0.969)]was better than that of a single indicator,and the sensitivity and specificity were 88.46％and 91.80％,respectively.Conclusion The levels of serum β-HB and HbA1c are elevated in DKA pediatric patients complicated with cerebral edema,which can predict the risk of cognitive dysfunction in DKA pediatric patients complicated with cerebral edema.The prediction is helpful for clinicians to intervene early and improve the prognosis of the pediatric patients.