Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis
Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis
复制标题
DOI：
10.1016/j.jpeds.2004.12.041
复制
发表时间：
2005-05-01
影响因子：
5.1
通讯作者：
Daneman, D
中科院分区：
文献类型：
--
作者：
Lawrence, SE;Cummings, EA;Daneman, D
目的确定加拿大儿童脑水肿合并糖尿病酮症酸中毒（CEDKA）的发生率、结局和危险因素。研究设计：本研究是在加拿大1999年7月至2001年6月以人群为基础的CEDKA主动监测研究中进行的病例对照研究。病例为DKA < 16岁伴脑水肿患者。每个病例有两个不匹配的对照组，即无脑水肿的DKA患者。结果监测期间共发现13例CEDKA，发病率0.51%；23%死亡，15%存活，伴有神经系统后遗症。19%的病例在最初出现DKA时存在CEDKA。CEDKA与较低的初始碳酸氢盐（P =.001）、较高的初始尿素（P =.001）和较高的血糖相关（P =. 014）。虽然有趋势与较高的液体流速和碳酸氢盐治疗相关，但这些并不是独立的预测因素。结论CEDKA仍然是一个严重的问题，死亡率很高。未发现CEDKA的发生与治疗因素之间存在关联。DKA治疗前脑水肿的存在以及与疾病严重程度的关联表明，预防DKA是避免这种破坏性并发症的关键。
Objectives To determine incidence, outcomes, and risk factors for pediatric cerebral edema with diabetic ketoacidosis (CEDKA) in Canada.Study design This was a case-control study nested within a population-based active surveillance study of CEDKA in Canada from July 1999 to June 2001. Cases are patients with DKA < 16 years of age with cerebral edema. Two unmatched control subjects per case are patients with DKA without cerebral edema.Results Thirteen cases of CEDKA were identified over the surveillance period for an incidence rate of 0.51%; 23% died and 15% survived with neurologic sequelae. CEDKA was present at initial presentation of DKA in 19% of cases. CEDKA was associated with lower initial bicarbonate (P =.001), higher initial urea (P =.001), and higher glucose at presentation (P = .014). Although there was a trend to association with higher fluid rates and treatment with bicarbonate, these were not independent predictors.Conclusions CEDKA remains a significant problem with a high mortality rate. No association was found between the occurrence of CEDKA and treatment factors. The presence of cerebral edema before treatment of DKA and the association with severity of illness suggest that prevention of DKA is the key to avoiding this devastating complication.