U-shaped relationship between early blood glucose and mortality in critically ill children.
U-shaped relationship between early blood glucose and mortality in critically ill children.
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危重儿童早期血糖与死亡率呈U型关系
DOI：
10.1186/s12887-015-0403-y
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发表时间：
2015-07-24
期刊：
影响因子：
2.4
通讯作者：
Feng X
中科院分区：
文献类型：
--
作者：
Li Y;Bai Z;Li M;Wang X;Pan J;Li X;Wang J;Feng X
本研究的目的是评估早期血糖浓度与死亡率之间的关系，并确定儿科重症监护病房（PICU）入院后24小时内血糖浓度的“安全范围”，以降低死亡率。我们进一步确定PICU死亡率与PICU入院后24小时内发生的早期高血糖和低血糖之间是否存在相关性，即使调整了由儿科死亡风险III（PRISM III）评分评估的疾病严重程度。这项回顾性队列研究纳入了2008年7月至2011年6月在一家三级教学医院入住PICU的患者。分析PICU入院后最初24 h的血糖值和平均血糖值。在1349名入院后24小时内至少测量了一次血糖值的儿童中，129名在PICU住院期间死亡。当分析入院时的血糖值和入院后24小时内的平均血糖值时，比较了血糖浓度≤65、65-90、90-110、110-140、140-200和>200 mg/dL的儿童的死亡率（≤3.6、3.6-5.0、5.0-6.1、6.1-7.8、7.8-11.1和>11.1 mmol/L）。葡萄糖浓度≤65 mg/dL（3.6 mmol/L）和>200 mg/dL（11.1 mmol/L）的儿童死亡率显著较高，表明葡萄糖浓度与死亡率之间存在U形关系。血糖浓度110-140 mg/dL（6.1-7.8 mmol/L），随后为90-110 mg/dL（5.0-6.1 mmol/L），与死亡风险最低相关，这表明危重患儿入院后24小时内血糖浓度的“安全范围”在90 - 140 mg/dL之间（5.0和7.8 mmol/L）。与平均血糖浓度为110-140 mg/dL（6.1-7.8 mmol/L）的患者相比，早期高血糖（>140 mg/dL [7.8 mmol/L]）和低血糖（≤65 mg/dL [3.6 mmol/L]）与死亡风险增加相关的比值比分别为4.13和15.13（p <0.001）。在调整PRISM III评分后，这种关联仍然显著（p <0.001）。危重患儿早期血糖浓度与PICU死亡率呈U型关系。早期高血糖和低血糖均与死亡率相关，即使调整了疾病严重程度。
The aims of this study are to evaluate the relationship between early blood glucose concentrations and mortality and to define a ‘safe range’ of blood glucose concentrations during the first 24 h after pediatric intensive care unit (PICU) admission with the lowest risk of mortality. We further determine whether associations exist between PICU mortality and early hyperglycemia and hypoglycemia occurring within 24 h of PICU admission, even after adjusting for illness severity assessed by the pediatric risk of mortality III (PRISM III) score. This retrospective cohort study included patients admitted to PICU between July 2008 and June 2011 in a tertiary teaching hospital. Both the initial admission glucose values and the mean glucose values over the first 24 h after PICU admission were analyzed. Of the 1349 children with at least one blood glucose value taken during the first 24 h after admission, 129 died during PICU stay. When analyzing both the initial admission and mean glucose values during the first 24 h after admission, the mortality rate was compared among children with glucose concentrations ≤65, 65-90, 90–110, 110–140, 140–200, and >200 mg/dL (≤3.6, 3.6–5.0, 5.0–6.1, 6.1–7.8, 7.8–11.1, and >11.1 mmol/L). Children with glucose concentrations ≤65 mg/dL (3.6 mmol/L) and >200 mg/dL (11.1 mmol/L) had significantly higher mortality rates, indicating a U-shaped relationship between glucose concentrations and mortality. Blood glucose concentrations of 110–140 mg/dL (6.1–7.8 mmol/L), followed by 90–110 mg/dL (5.0–6.1 mmol/L), were associated with the lowest risk of mortality, suggesting that a ‘safe range’ for blood glucose concentrations during the first 24 h after admission in critically ill children exists between 90 and 140 mg/dL (5.0 and 7.8 mmol/L). The odds ratios of early hyperglycemia (>140 mg/dL [7.8 mmol/L]) and hypoglycemia (≤65 mg/dL [3.6 mmol/L]) being associated with increased risk of mortality were 4.13 and 15.13, respectively, compared to those with mean glucose concentrations of 110–140 mg/dL (6.1–7.8 mmol/L) (p <0.001). The association remained significant after adjusting for PRISM III scores (p <0.001). There was a U-shaped relationship between early blood glucose concentrations and PICU mortality in critically ill children. Both early hyperglycemia and hypoglycemia were associated with mortality, even after adjusting for illness severity.