Wang Huabin, He Zhongyuan, Li Jiahong, Lin Chao, Li Huan, Jin Ping, Chen Chun
Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
Department of Pediatric Intensive Care Unit, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
Front Pediatr. 2021 Sep 16;9:745204. doi: 10.3389/fped.2021.745204. eCollection 2021.
Identifying high-risk children with a poor prognosis in pediatric intensive care units (PICUs) is critical. The aim of this study was to assess the predictive value of early plasma osmolality levels in determining the clinical outcomes of children in PICUs. We retrospectively assessed critically ill children in a pediatric intensive care database. The locally weighted-regression scatter-plot smoothing (LOWESS) method was used to explore the approximate relationship between plasma osmolality and in-hospital mortality. Linear spline functions and stepwise expansion models were applied in conjunction with a multivariate logistic regression to further analyze this relationship. A subgroup analysis by age and complications was performed. In total, 5,620 pediatric patients were included in this study. An approximately "U"-shaped relationship between plasma osmolality and mortality was detected using LOWESS. In the logistic regression model using a linear spline function, plasma osmolality ≥ 290 mmol/L was significantly associated with in-hospital mortality [odds ratio (OR) 1.020, 95% confidence interval (CI) 1.010-1.031], while plasma osmolality <290 mmol/L was not significantly associated with in-hospital mortality (OR 0.990, 95% CI 0.966-1.014). In the logistic regression model with plasma osmolality as a tri-categorical variable, only high osmolality was significantly associated with in-hospital mortality (OR 1.90, 95% CI 1.38-2.64), whereas low osmolality was not associated with in-hospital mortality (OR 1.28, 95% CI 0.84-1.94). The interactions between plasma osmolality and age or complications were not significant. High osmolality, rather than low osmolality, can predict a poor prognosis in children in PICUs.
识别儿科重症监护病房（PICU）中预后不良的高危儿童至关重要。本研究的目的是评估早期血浆渗透压水平对确定PICU中儿童临床结局的预测价值。我们回顾性评估了儿科重症监护数据库中的危重症儿童。采用局部加权回归散点图平滑（LOWESS）方法探索血浆渗透压与院内死亡率之间的近似关系。线性样条函数和逐步扩展模型与多因素逻辑回归相结合，进一步分析这种关系。进行了年龄和并发症的亚组分析。本研究共纳入5620例儿科患者。使用LOWESS检测到血浆渗透压与死亡率之间呈近似“U”形关系。在使用线性样条函数的逻辑回归模型中，血浆渗透压≥290 mmol/L与院内死亡率显著相关[比值比（OR）1.020，95%置信区间（CI）1.010 - 1.031]，而血浆渗透压<290 mmol/L与院内死亡率无显著相关性（OR 0.990，95% CI 0.966 - 1.014）。在将血浆渗透压作为三分类变量的逻辑回归模型中，只有高渗透压与院内死亡率显著相关（OR 1.90，95% CI 1.38 - 2.64），而低渗透压与院内死亡率无关（OR 1.28，95% CI 0.84 - 1.94）。血浆渗透压与年龄或并发症之间的交互作用不显著。高渗透压而非低渗透压可预测PICU中儿童的预后不良。
