McCluskey Casey K, Zee-Cheng Janine E, Klein Margaret J, Scanlon Matthew C, Rotta Alexandre T, Remy Kenneth E, Carroll Christopher L, Shein Steven L
Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, United States.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.
Front Pediatr. 2022 Mar 11;10:812265. doi: 10.3389/fped.2022.812265. eCollection 2022.
The incidence of pediatric diabetic ketoacidosis (DKA) increased early in the COVID-19 pandemic, but the relative contribution of behavioral changes and viral-related pathophysiology are unknown.
To evaluate the relationship between school closure date and onset of increased DKA to help clarify the etiology of the increased incidence.
A multi-center, quality-controlled Pediatric Intensive Care Unit (PICU) database was used to identify the number of admissions to a participating PICU with DKA on each calendar day from 60 days before local school closure to 90 days after, and compared to baseline data from the same periods in 2018-2019. Interrupted time series and multiple linear regression analyses were used to identify admission rates that differed significantly between 2020 and baseline.
Eighty-one PICUs in the United StatesParticipants: Children ages 29 days to 17 years admitted to a PICU with DKAExposures: Statewide school closureMain outcome/measure: Rate of admission to the PICU for DKA.
There were 1936 admissions for children with DKA in 2020 and 1795 admissions/year to those same PICUs in 2018-2019. Demographics and clinical outcomes did not differ before school closure, but pandemic-era patients were less often white and had longer hospital length of stay in the post-school closure period. The difference between 2020 admissions and 2018-2019 admissions was not different than zero before school closure, and significantly higher than zero after school closure, but was significantly increased in 2020 at >30 days after school closure ( = 0.039).
CONCLUSIONS/RELEVANCE: An increase in pediatric DKA admissions began one month after school closures. Given that behavioral changes started near school closure dates and viral activity peaked weeks after, this suggests that behavioral factors may not be the primary etiology and it is possible that SARS-CoV-2 infection may have direct effects on pediatric DKA.
在新冠疫情早期，儿童糖尿病酮症酸中毒（DKA）的发病率有所上升，但行为改变和病毒相关病理生理学的相对贡献尚不清楚。
评估学校关闭日期与DKA发病率增加的发病时间之间的关系，以帮助阐明发病率增加的病因。
使用一个多中心、质量控制的儿科重症监护病房（PICU）数据库，确定从当地学校关闭前60天到关闭后90天内，每个日历日参与研究的PICU收治DKA患儿的数量，并与2018 - 2019年同期的基线数据进行比较。采用中断时间序列和多元线性回归分析来确定2020年与基线之间有显著差异的入院率。
美国的81个PICU
年龄在29天至17岁之间因DKA入住PICU的儿童
全州范围的学校关闭
主要结局/指标：DKA患儿入住PICU的比率。
2020年有1936例DKA患儿入院，2018 - 2019年这些PICU每年有1795例入院。在学校关闭前，人口统计学和临床结局无差异，但疫情期间的患者白人较少，且在学校关闭后的住院时间更长。2020年入院人数与2018 - 2019年入院人数的差异在学校关闭前不显著高于零，在学校关闭后显著高于零，但在2020年学校关闭后>30天显著增加（P = 0.039）。
结论/意义：儿童DKA入院人数在学校关闭后一个月开始增加。鉴于行为改变在学校关闭日期附近开始，而病毒活动在数周后达到峰值，这表明行为因素可能不是主要病因，SARS-CoV-2感染可能对儿童DKA有直接影响。
