Department of Endocrinology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Rd, Nanjing, 210008, China.
Department of Emergency, Pediatric intensive care unit, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
BMC Pediatr. 2022 Apr 13;22(1):206. doi: 10.1186/s12887-022-03243-z.
Precision treatment of pediatric diabetic ketoacidosis (DKA) has been the focus of research for decades. Whether the timing of the initiation of dietary intake contributes to DKA correction is ignored.
We conducted a retrospective study to investigate the effects of the timing of the initiation of dietary intake on DKA correction in Children's Hospital of Nanjing Medical University, a tertiary children's hospital, from June 2017 to December 2020. Individual basic characteristic and clinical information of all DKA cases (n = 183) were collected. Multiple linear regression, logistic regression model and random forest (RF) model were used to assess the effect of the timing of the initiation of dietary intake on DKA correction.
The mean age of the children diagnosed with DKA was 6.95 (SD 3.82) years. The median DKA correction time and the timing of the initiation of dietary intake was 41.72 h and 3.13 h, respectively. There were 62.3% (n = 114) patients corrected DKA at the end of the 48-h rehydration therapy. For each hour delay in starting dietary intake, child's DKA correction was prolonged by 0.5 (95% CI 1.05, 1.11, P < 0.001) hours and the adjusted odds of DKA over 48 h was increased by 8% (OR = 1.08, 95% CI: 1.05, 1.11, P < 0.001) after adjustment for potential confounders. The RF model based on the timing of the initiation of dietary intake and child's weight and systolic pressure achieved the highest AUC of 0.789.
Pediatricians should pay attention to the effect of the timing of the initiation of dietary intake, a controllable factor, on DKA correction.
几十年来，儿科糖尿病酮症酸中毒（DKA）的精准治疗一直是研究的重点。启动饮食摄入的时间是否有助于 DKA 纠正尚未得到关注。
我们进行了一项回顾性研究，以调查南京医科大学附属儿童医院（一家三级儿童医院） 2017 年 6 月至 2020 年 12 月期间启动饮食摄入的时间对 DKA 纠正的影响。收集了所有 DKA 病例（n=183）的个体基本特征和临床信息。使用多元线性回归、逻辑回归模型和随机森林（RF）模型评估启动饮食摄入的时间对 DKA 纠正的影响。
诊断为 DKA 的儿童的平均年龄为 6.95（SD 3.82）岁。DKA 纠正的中位时间和启动饮食摄入的时间分别为 41.72 h 和 3.13 h。62.3%（n=114）的患者在 48 h 补液治疗结束时纠正了 DKA。启动饮食摄入每延迟 1 小时，儿童的 DKA 纠正时间延长 0.5 小时（95%CI 1.05，1.11，P<0.001），调整潜在混杂因素后，DKA 持续时间超过 48 h 的调整后比值比增加 8%（OR=1.08，95%CI：1.05，1.11，P<0.001）。基于启动饮食摄入时间和儿童体重和收缩压的 RF 模型实现了 0.789 的最高 AUC。
儿科医生应注意启动饮食摄入的时间（一个可控因素）对 DKA 纠正的影响。
