Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
Pediatric Intensive Care Unit, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
Nutrition. 2018 Apr;48:105-110. doi: 10.1016/j.nut.2017.11.020. Epub 2017 Dec 7.
To test the hypothesis that low blood thiamine concentrations in malnourished critically ill children are associated with higher risk of 30-d mortality.
Prospective cohort study in 202 consecutively admitted children who had whole blood thiamine concentrations assessed on admission and on days 5 and 10 of intensive care unit (ICU) stay. The primary outcome variable was 30-d mortality. Mean blood thiamine concentrations within the first 10 d of ICU stay, age, sex, malnutrition, C-reactive protein concentration, Pediatric Index of Mortality 2 score, and severe sepsis/septic shock were the main potential exposure variables for outcome.
Thiamine deficiency was detected in 61 patients within the first 10 d of ICU stay, 57 cases being diagnosed on admission and 4 new cases on the 5th d. C-reactive protein concentration during ICU stay was independently associated with decreased blood thiamine concentrations (P = 0.003). There was a significant statistical interaction between mean blood thiamine concentrations and malnutrition on the risk of 30-d mortality (P = 0.002). In an adjusted analysis, mean blood thiamine concentrations were associated with a decrease in the mortality risk in malnourished patients (odds ratio = 0.85; 95% confidence interval [CI]: 0.73-0.98; P = 0.029), whereas no effect was noted for well-nourished patients (odds ratio: 1.03; 95% CI: 0.94-1.13; P = 0.46).
Blood thiamine concentration probably has a protective effect on the risk of 30-d mortality in malnourished patients but not in those who were well nourished.
验证假设，即营养不良的危重症患儿血液中硫胺素浓度较低与 30 天死亡率升高相关。
对 202 例连续入院的患儿进行前瞻性队列研究，在入院时和重症监护病房（ICU）入住第 5 天和第 10 天评估全血硫胺素浓度。主要结局变量为 30 天死亡率。ICU 入住前 10 天内的平均血液硫胺素浓度、年龄、性别、营养不良、C 反应蛋白浓度、儿科死亡率 2 评分和严重脓毒症/感染性休克是主要的潜在暴露变量。
在 ICU 入住的前 10 天内，有 61 例患儿检测到硫胺素缺乏，其中 57 例在入院时诊断，4 例在第 5 天新诊断。ICU 期间的 C 反应蛋白浓度与血液硫胺素浓度降低独立相关（P=0.003）。平均血液硫胺素浓度与营养不良对 30 天死亡率的风险之间存在显著的统计学交互作用（P=0.002）。在调整分析中，平均血液硫胺素浓度与营养不良患儿的死亡率风险降低相关（比值比=0.85；95%置信区间 [CI]：0.73-0.98；P=0.029），而对营养良好的患儿无影响（比值比：1.03；95%CI：0.94-1.13；P=0.46）。
血液硫胺素浓度可能对营养不良患儿 30 天死亡率的风险有保护作用，但对营养良好的患儿无此作用。
