Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan.
Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan.
Sci Rep. 2019 Nov 8;9(1):16311. doi: 10.1038/s41598-019-52928-6.
This was a retrospective study of pediatric trauma patients and were hospitalized in a level-1 trauma center from January 1, 2009 to December 31, 2016. Stress-induced hyperglycemia (SIH) was defined as a hyperglycemia level ≥200 mg/dL upon arrival at the emergency department without any history of diabetes or a hemoglobin A1c level ≥6.5% upon arrival or during the first month of admission. The results demonstrated that the patients with SIH (n = 36) had a significantly longer length of stay (LOS) in hospital (16.4 vs. 7.8 days, p = 0.002), higher rates of intensive care unit (ICU) admission (55.6% vs. 20.9%, p < 0.001), and higher in-hospital mortality rates (5.6% vs. 0.6%, p = 0.028) compared with those with non-diabetic normoglycemia (NDN). However, in the 24-pair well-balanced propensity score-matched patient populations, in which significant difference in sex, age, and injury severity score were eliminated, patient outcomes in terms of LOS in hospital, rate of ICU admission, and in-hospital mortality rate were not significantly different between the patients with SIH and NDN. The different baseline characteristics of the patients, particularly injury severity, may be associated with poorer outcomes in pediatric trauma patients with SIH compared with those with NDN. This study also indicated that, upon major trauma, the response of pediatric patients with SIH is different from that of adult patients.
这是一项回顾性研究，纳入了 2009 年 1 月 1 日至 2016 年 12 月 31 日期间在一家 1 级创伤中心住院的儿科创伤患者。应激性高血糖（SIH）定义为到达急诊室时血糖水平≥200mg/dL，且无糖尿病病史或入院时或入院第一个月内的糖化血红蛋白水平≥6.5%。结果表明，有 SIH 的患者（n=36）的住院时间（LOS）明显延长（16.4 天 vs. 7.8 天，p=0.002），入住重症监护病房（ICU）的比例更高（55.6% vs. 20.9%，p<0.001），院内死亡率也更高（5.6% vs. 0.6%，p=0.028），与非糖尿病性正常血糖（NDN）患者相比。然而，在 24 对经过良好平衡的倾向评分匹配的患者人群中，消除了性别、年龄和损伤严重程度评分的显著差异后，SIH 患者与 NDN 患者在 LOS、ICU 入住率和院内死亡率方面的患者结局无显著差异。患者的基线特征不同，特别是损伤严重程度，可能与 SIH 儿科创伤患者的预后较差有关。本研究还表明，在遭受重大创伤后，SIH 患儿的反应与成人患者不同。
