Hasan Rashed A, Hesen Jacob Z, Millican Nicklaus, Pederson John M, Agus Michael S D
Hurley Medical Center, Flint, MI.
Michigan State University, East Lansing, MI.
Pediatr Crit Care Med. 2025 Jan 1;26(1):e77-e85. doi: 10.1097/PCC.0000000000003649. Epub 2024 Nov 22.
To assess factors associated with serum phosphorus (P) and hypophosphatemia in children with type 1 diabetes mellitus (T1DM) treated for diabetic ketoacidosis (DKA).
Retrospective cohort.
Community-based PICU in a university-affiliated hospital.
Patients 1-20 years old with T1DM hospitalized for DKA from July 1, 2016, to July 31, 2022.
None.
We collected age, sex, duration of T1DM, conscious state at presentation, and most recent glycohemoglobin level. P was tested initially and then every 4 hours. Probability of hypophosphatemia and time to hypophosphatemia and hospital length of stay (LOS) were analyzed via binomial and linear mixed-effects regression analyses, respectively. A total of 852 DKA episodes occurred in 365 patients (46.3% female, median age 14.7 yr), of which 158 (18.5%) episodes were new-onset T1DM. Hypophosphatemia developed during 656 of 852 (77%) episodes, including 49 of 852 (5.8%) episodes of severe hypophosphatemia with median (interquartile range) onset 8.0 hours (4.7-11.9 hr) and 12.0 hours (8.1-17.6 hr), respectively, following initiation of therapy. Higher glycohemoglobin was associated with greater odds of hypophosphatemia (odds ratio [OR], 1.22; p < 0.001). However, lower odds of hypophosphatemia were associated with older age (OR, 0.89; p < 0.01), male (OR, 0.11; p = 0.01), longer T1DM duration (OR, 0.87; p < 0.001), and having initial normal conscious state (OR, 0.18; p < 0.01). Older age (3.0%/yr; p = 0.02), T1DM duration (4.1%/yr; p = 0.01), and initial serum P (23.4%/mg/dL; p < 0.001) were associated with later hypophosphatemia. LOS was shorter with increased T1DM duration (3.6%/yr; p < 0.001) and normal conscious state (33.1% shorter; p < 0.001), but longer with increasing glycohemoglobin (4.0%; p < 0.001). All patients survived with normal neurologic function.
Higher glycohemoglobin was associated with greater odds of hypophosphatemia and longer LOS. Older male, longer duration of T1DM, and conscious at admission were factors associated with lower odds of developing hypophosphatemia and with later onset when it occurred. Hypophosphatemia was associated with longer LOS.
评估1型糖尿病（T1DM）患儿糖尿病酮症酸中毒（DKA）治疗期间血清磷（P）及低磷血症相关因素。
回顾性队列研究。
大学附属医院基于社区的儿科重症监护病房。
2016年7月1日至2022年7月31日因DKA住院的1 - 20岁T1DM患者。
无。
收集年龄、性别、T1DM病程、就诊时意识状态及最近糖化血红蛋白水平。最初检测P，之后每4小时检测一次。分别通过二项式和线性混合效应回归分析低磷血症发生概率、低磷血症发生时间及住院时间（LOS）。365例患者共发生852次DKA发作（女性占46.3%，中位年龄14.7岁），其中158次发作（18.5%）为新发T1DM。852次发作中有656次（77%）发生低磷血症，包括852次发作中的49次（5.8%）严重低磷血症，治疗开始后中位（四分位间距）发作时间分别为8.0小时（4.7 - 11.9小时）和12.0小时（8.1 - 17.6小时）。较高的糖化血红蛋白与低磷血症发生几率增加相关（比值比[OR]，1.22；p < 0.001）。然而，低磷血症发生几率较低与年龄较大（OR，0.89；p < 0.01）、男性（OR，0.11；p = 0.01）、T1DM病程较长（OR，0.87；p < 0.001）及初始意识状态正常（OR，0.18；p < 0.01）相关。年龄较大（3.0%/年；p = 0.02）、T1DM病程（4.1%/年；p = 0.01）及初始血清P（23.4%/mg/dL；p < 0.001）与低磷血症发生较晚相关。LOS随T1DM病程增加（3.6%/年；p < 0.001）及意识状态正常而缩短（缩短33.1%；p < 0.001），但随糖化血红蛋白升高而延长（4.0%；p < 0.001）。所有患者均存活且神经功能正常。
较高的糖化血红蛋白与低磷血症发生几率增加及LOS延长相关。年龄较大的男性、T1DM病程较长及入院时意识清醒是低磷血症发生几率较低及发生时发作较晚的相关因素。低磷血症与LOS延长相关。
