Fendler Wojciech, Walenciak Justyna, Mlynarski Wojciech, Piotrowski Andrzej
Department of Pediatrics, Oncology, Hematology and Diabetology, Lodz, Poland.
J Matern Fetal Neonatal Med. 2012 Jul;25(7):1122-6. doi: 10.3109/14767058.2011.624220. Epub 2011 Oct 19.
To determine the association between mean glycemia and its variability with perinatal mortality in preterm newborns hospitalized in an intensive care unit (ICU).
Patients admitted to the ICU within the first 12 hours of life, with birth weight <1500 g, at least three blood glucose measurements/day and lack of insulin treatment were evaluated. Association of mean glycemia and its standard deviation (SD) with death during initial 7 days of life was evaluated. Multivariate logistic regression analysis was performed twice, using continuous glucose concentrations and by means of a quintile-based approach correcting for nonnormal distribution and nonlinear effects.
A total of 95 newborns were enrolled. Eleven patients (11.5%) died during the initial 7 days of life, overall mortality equaled 22%. Multivariate analysis showed that 5 minute Apgar score and SD of glucose concentrations were significantly associated with increased mortality in both models. Odds ratios (ORs) equaled 0.44; 95% confidence interval (95% CI) 0.27-0.74 and OR 1.34; 95% CI 1.03-2.03 for the continuous model and 0.50 95% CI 0.34-0.75 and OR 1.82 95% CI 1.07-3.11 for the quintile-based model. In both cases, mean glycemia was removed during the stepwise model-building procedure.
Higher glycemic variability may be associated with greater odds of perinatal mortality.
确定重症监护病房（ICU）住院早产儿的平均血糖及其变异性与围产期死亡率之间的关联。
对出生后12小时内入住ICU、出生体重<1500 g、每天至少进行三次血糖测量且未接受胰岛素治疗的患者进行评估。评估平均血糖及其标准差（SD）与出生后最初7天内死亡的关联。使用连续血糖浓度并通过基于五分位数的方法进行两次多因素逻辑回归分析，以校正非正态分布和非线性效应。
共纳入95例新生儿。11例患者（11.5%）在出生后最初7天内死亡，总死亡率为22%。多因素分析显示，在两个模型中，5分钟阿氏评分和血糖浓度标准差均与死亡率增加显著相关。连续模型的比值比（OR）为0.44；95%置信区间（95%CI）为0.27 - 0.74，基于五分位数模型的OR为1.34；95%CI为1.03 - 2.03。连续模型的OR为0.50，95%CI为0.34 - 0.75，基于五分位数模型的OR为1.82，95%CI为1.07 - 3.11。在两种情况下，逐步模型构建过程中均剔除了平均血糖。
较高的血糖变异性可能与围产期死亡几率增加有关。
