BACKGROUND Cardiac troponin I displays significant prognostic value in acute coronary syndromes and in other non-coronary conditions and systemic illnesses. Elevated levels of this biomarker in the setting of diabetic ketoacidosis may also provide useful prognostic information regarding outcome. METHODS A systematic review of the English language medical literature was performed using PubMed. Articles reporting original data on major clinical outcomes on cohorts of patients were included. RESULTS Three reports examining the relationship between cardiac troponin I and clinical outcomes in patients with diabetic ketoacidosis qualified for review. A spectrum of electrolyte and cardiac abnormalities were observed in the studied populations which were more frequent in those with troponin elevations. Short- and long-term outcomes appeared worse for patients with elevated troponin levels, but small study populations and other experimental issues including concurrent diseases which could have confounded the apparent relationship between troponin concentrations and outcome reduced the confidence of the findings. CONCLUSIONS The available literature suggests an association between elevated cardiac-specific troponin I serum concentrations and clinical outcomes among diabetic patients with ketoacidosis, but data are insufficient to draw conclusions at this time. Large prospective observational studies which exclude or control for other conditions which could contribute to troponin release will be needed before the predictive value of this biomarker in ketoacidosis can be reliably defined.