Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.
Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.
复制标题
糖尿病酮症酸中毒患儿脑水肿的危险因素
DOI：
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复制
发表时间：
2001
影响因子：
158.5
通讯作者：
N. Kuppermann
中科院分区：
文献类型：
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作者：
N. Glaser;P. Barnett;I. McCaslin;David L. Nelson;J. Trainor;J. Louie;F. Kaufman;K. Quayle;M. Roback;R. Malley;N. Kuppermann
背景
脑水肿是儿童糖尿病酮症酸中毒的一种罕见但破坏性的并发症。这种并发症的风险因素尚未明确定义。
方法
在这项多中心研究中，我们确定了61名在15年内因糖尿病酮症酸中毒住院并发生脑水肿的儿童。还确定了另外两组患有糖尿病酮症酸中毒但无脑水肿的儿童：181名随机选择的儿童和174名与脑水肿组相匹配的儿童，这些儿童在就诊时的年龄、糖尿病发作情况、（确诊与新诊断疾病），初始血清葡萄糖浓度，使用逻辑回归，我们比较了三组的人口统计学特征和生化变量，并比较了匹配组的治疗干预和变化在治疗期间的生化值。
结果
脑水肿组儿童与随机对照组儿童的比较显示，脑水肿与较低的初始动脉二氧化碳分压显著相关（每降低7.8 mm Hg [代表1 SD]，脑水肿的相对风险为3.4; 95%置信区间为1.9至6.3; P<0.001）和较高的初始血清尿素氮浓度（每增加9 mg/dl [3.2 mmol/L] [代表1 SD]，脑水肿的相对风险为1.7; 95%置信区间为1.2 ~ 2.5; P=0.003）。脑水肿儿童与对照组的比较也表明，脑水肿与较低的动脉二氧化碳分压和较高的血清尿素氮浓度有关。在治疗变量中，调整其他协变量后，只有碳酸氢盐治疗与脑水肿相关（相对危险度，4.2; 95%置信区间，1.5 - 12.1; P=0.008）。
结论
患有糖尿病酮症酸中毒的儿童，在就诊时动脉二氧化碳分压低，血清尿素氮浓度高，并接受碳酸氢盐治疗，发生脑水肿的风险增加。
BACKGROUND
Cerebral edema is an uncommon but devastating complication of diabetic ketoacidosis in children. Risk factors for this complication have not been clearly defined.
METHODS
In this multicenter study, we identified 61 children who had been hospitalized for diabetic ketoacidosis within a 15-year period and in whom cerebral edema had developed. Two additional groups of children with diabetic ketoacidosis but without cerebral edema were also identified: 181 randomly selected children and 174 children matched to those in the cerebral-edema group with respect to age at presentation, onset of diabetes (established vs. newly diagnosed disease), initial serum glucose concentration, and initial venous pH. Using logistic regression we compared the three groups with respect to demographic characteristics and biochemical variables at presentation and compared the matched groups with respect to therapeutic interventions and changes in biochemical values during treatment.
RESULTS
A comparison of the children in the cerebral-edema group with those in the random control group showed that cerebral edema was significantly associated with lower initial partial pressures of arterial carbon dioxide (relative risk of cerebral edema for each decrease of 7.8 mm Hg [representing 1 SD], 3.4; 95 percent confidence interval, 1.9 to 6.3; P<0.001) and higher initial serum urea nitrogen concentrations (relative risk of cerebral edema for each increase of 9 mg per deciliter [3.2 mmol per liter] [representing 1 SD], 1.7; 95 percent confidence interval, 1.2 to 2.5; P=0.003). A comparison of the children with cerebral edema with those in the matched control group also showed that cerebral edema was associated with lower partial pressures of arterial carbon dioxide and higher serum urea nitrogen concentrations. Of the therapeutic variables, only treatment with bicarbonate was associated with cerebral edema, after adjustment for other covariates (relative risk, 4.2; 95 percent confidence interval, 1.5 to 12.1; P=0.008).
CONCLUSIONS
Children with diabetic ketoacidosis who have low partial pressures of arterial carbon dioxide and high serum urea nitrogen concentrations at presentation and who are treated with bicarbonate are at increased risk for cerebral edema.