Hyperglycemia is associated with morbidity in critically ill children with meningococcal sepsis
Hyperglycemia is associated with morbidity in critically ill children with meningococcal sepsis
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DOI：
10.1097/pcc.0b013e31818d350b
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发表时间：
2008-11-01
影响因子：
4.1
通讯作者：
Inwald, David P.
中科院分区：
文献类型：
--
作者：
Day, Kerry M.;Haub, Nadja;Inwald, David P.
目的：探讨高血糖与脑膜炎球菌脓毒症患儿通气预后的关系。设计：回顾案例记录。环境：伦敦有8个床位的儿科重症监护病房。患者：2001-2004年因脑膜炎球菌败血症而连续通气的儿童。干预措施:没有。测量：测定整个住院期间的血糖峰值，并计算以下三个时期的平均血糖：1)前24小时，2)后24小时，3)整个儿科重症监护病房住院期间。患者也根据他们的血糖在儿科重症监护病房入院期间是否上升到bbb7 mmol/L (126 mg/dL), > 10 mmol/L （180 mg/dL）或保持低于这些水平进行分组。结局指标为预测死亡率（基于儿科死亡风险评分）、30天无呼吸机天数、院内感染、肾脏替代疗法的使用、intropes的使用和皮肤坏死。主要结果：97例患者，中位年龄2.1岁，中位住院时间4天。4名患者死亡。血糖峰值与预测死亡率显著相关，与30天无呼吸机天数负相关（分别p < 0.001和p < 0.001）。接受肾脏替代治疗或肌力支持，或发生院内感染或皮肤坏死的患者血糖峰值明显高于未接受治疗的患者（p = 0.006, p < 0.0001, p = 0.022和p < 0.0001）。接受肾脏替代治疗或发生皮肤坏死的患者在入院后24小时的平均血糖显著升高（p = 0.017和p = 0.004）。然而，前24小时和整个入院期间的平均血糖与结果无关。被定义为高血糖且血糖为bbb7 mmol/L或>0 mmol/L的患者的预后也明显比血糖维持在这些水平以下的患者差。高甘油血症与预后之间存在显著关联。我们的结果支持在这组危重儿童中进行严格血糖控制的试验。（儿科危重护理医学2008；9:636-640）
Objective: To determine the association between hyperglycemia and outcome in children ventilated for meningococcal sepsis.Design: Retrospective case notes review. Setting: Eight bedded pediatric intensive care unit in London.Patients: Consecutive children ventilated for meningococcal sepsis 2001-2004.Interventions: None.Measurements: Peak glucose for the entire admission was determined and mean glucose was calculated for the following three epochs: 1) first 24 hrs, 2) second 24 hrs, and 3) the entire pediatric intensive care unit admission. Patients were also grouped according to whether their blood glucose rose to > 7 mmol/L (126 mg/dL), > 10 mmol/L (180 mg/dL), or remained below these levels during the pediatric intensive care unit admission. Outcome measures were predicted mortality (based on pediatric risk of mortality score), ventilator free days at 30 days, nosocomial infection, use of renal replacement therapy, use of intropes, and skin necrosis.Main Results: Ninety-seven patients were identified with a median age of 2.1 yrs and a median length of stay of 4 days. Four patients died. Peak glucose significantly correlated with predicted mortality and negatively correlated with ventilator free days at 30 days (p < 0.001 and p < 0.001, respectively). Patients who received renal replacement therapy or inotropic support, or developed a nosocomial infection or skin necrosis had significantly higher peak glucose than those who did not (p = 0.006, p < 0.0001, p = 0.022, and p < 0.0001, respectively). Patients who received renal replacement therapy or who developed skin necrosis had significantly higher mean blood glucose in the second 24 hrs of admission (p = 0.017 and p = 0.004, respectively). However, mean blood glucose in the first 24 hrs and over the entire admission did not correlate with outcome. Patients defined as hyperglycemic with blood glucose either > 7 mmol/L or > 10 mmol/L also had a significantly worse outcome than those who maintained blood glucose below these levels.Conclusions. There was a significant association between hyperglycernia and outcome. Our results support a trial of tight glycemic control in this group of critically ill children. (Pediatr Crit Care Med 2008; 9:636-640)