Toro-Polo Luis Miguel, Ortiz-Lozada Ricardo Yannick, Chang-Grozo Silvana Lucia, Hernandez Adrian V, Escalante-Kanashiro Raffo, Solari-Zerpa Lely
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru.
Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru.
Rev Bras Ter Intensiva. 2018 Oct-Dec;30(4):471-478. doi: 10.5935/0103-507X.20180068.
To analyze the association between glycemia levels upon pediatric intensive care unit admission and mortality in patients hospitalized.
A retrospective cohort of pediatric intensive care unit patients admitted to the Instituto Nacional de Salud del Niño between 2012 and 2013. A Poisson regression model with robust variance was used to quantify the association. Diagnostic test performance evaluation was used to describe the sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios for each range of glycemia.
In total, 552 patients were included (median age 23 months, age range 5 months to 79.8 months). The mean glycemia level upon admission was 121.3mg/dL (6.73mmol/L). Ninety-two (16.6%) patients died during hospitalization. In multivariable analyses, significant associations were found between glycemia < 65mg/dL (3.61mmol/L) (RR: 2.01, 95%CI 1.14 - 3.53), glycemia > 200mg/dL (> 11.1mmol/L) (RR: 2.91, 95%CI 1.71 - 4.55), malnutrition (RR: 1.53, 95%CI 1.04 - 2.25), mechanical ventilation (RR: 3.71, 95%CI 1.17 - 11.76) and mortality at discharge. There was low sensitivity (between 17.39% and 39.13%) and high specificity (between 49.13% and 91.74%) for different glucose cut-off levels.
There was an increased risk of death at discharge in patients who developed hypoglycemia and hyperglycemia upon admission to the pediatric intensive care unit. Certain glucose ranges (> 200mg/dL (> 11.1mmol/L) and < 65mg/dL (3.61mmol/L)) have high specificity as predictors of death at discharge.
分析儿科重症监护病房入院时血糖水平与住院患者死亡率之间的关联。
对2012年至2013年期间入住国家儿童健康研究所的儿科重症监护病房患者进行回顾性队列研究。使用具有稳健方差的泊松回归模型来量化这种关联。采用诊断试验性能评估来描述每个血糖范围的敏感性、特异性、阳性预测值、阴性预测值和似然比。
共纳入552例患者（中位年龄23个月，年龄范围5个月至79.8个月）。入院时的平均血糖水平为121.3mg/dL（6.73mmol/L）。92例（16.6%）患者在住院期间死亡。在多变量分析中，发现血糖<65mg/dL（3.61mmol/L）（相对危险度：2.01，95%置信区间1.14 - 3.53）、血糖>200mg/dL（>11.1mmol/L）（相对危险度：2.91，95%置信区间1.71 - 4.55）、营养不良（相对危险度：1.53，95%置信区间1.04 - 2.25）、机械通气（相对危险度：3.71，95%置信区间1.17 - 11.76）与出院时死亡率之间存在显著关联。不同血糖临界值水平的敏感性较低（在17.39%至39.13%之间），特异性较高（在49.13%至91.74%之间）。
儿科重症监护病房入院时发生低血糖和高血糖的患者出院时死亡风险增加。特定的血糖范围（>200mg/dL（>11.1mmol/L）和<65mg/dL（3.61mmol/L））作为出院时死亡的预测指标具有较高的特异性。
