Liu Wenjun, Dong Milan, Li Jing, Zhang Guoying, Chen Ju, Jiang Jianyu, Duan Ling, Xiong Daoxue, Huang Bo, Zou Yingbo, Liu Fuyan, Fu Hongmin, Yu Kai
Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China.
Department of Pediatrics, Women and Children's Hospital of Chongqing Medical University, Chongqing Health Center for Women and Children, Chongqing, China.
Front Endocrinol (Lausanne). 2025 Jun 18;16:1518746. doi: 10.3389/fendo.2025.1518746. eCollection 2025.
The available evidence on tight glycemic control is conflicting, while the interaction between glucose and lactate in critically ill children remains unclear.
To explore the potential role of hyperlactatemia (HL) in modulating the relationship between stress hyperglycemia (SHG) and poor outcomes, aiming to establish tailored glucose targets in critically ill children.
This was a secondary analysis of a prospective observational cohort study conducted in five Pediatric Intensive Care Units (PICU) in southwestern China (ChiCTR2000030846). The interaction effect between glucose and lactate metrics concerning outcomes and subsequent subgroup regression analysis was conducted. SHG was defined as glucose > 150 mg/dL(8.3mmol/L) and HL as lactate > 2 mmol/L.
A cohort of 433 pediatric patients with 4885 arterial blood gas measurements were finally enrolled. 90 (20.8%) cases died within 28 days of PICU admission. Significant interaction effects between SHG and HL on outcomes were observed (p < 0.05). In the non-HL group, SHG was not an independent predictor of 28-day mortality (p = 0.656) and was not correlated with either 28-day ventilator-free days (p = 0.916) or 28-day ICU-free days (p = 0.914). In contrast, in the HL group, SHG was independently associated with 28-day mortality (OR 3.55, 95% CI 1.62~7.80, p = 0.002) and correlated with a reduction of 5.04 28-day ventilator-free days (p = 0.003) and 4.10 28-day ICU-free days (p = 0.004).
HL potentially modulates the correlation between SHG and poor outcomes in pediatric critically ill patients. Combined SHG and HL are associated with poor outcomes, whereas SHG without HL is not.
关于严格血糖控制的现有证据相互矛盾，而危重症儿童中葡萄糖与乳酸之间的相互作用仍不清楚。
探讨高乳酸血症（HL）在调节应激性高血糖（SHG）与不良预后之间关系中的潜在作用，旨在为危重症儿童确定合适的血糖目标。
这是一项对在中国西南部五个儿科重症监护病房（PICU）进行的前瞻性观察队列研究的二次分析（ChiCTR2000030846）。对血糖和乳酸指标与预后之间的相互作用效应以及随后的亚组回归分析进行了研究。SHG定义为血糖>150mg/dL（8.3mmol/L），HL定义为乳酸>2mmol/L。
最终纳入了433例儿科患者，共进行了4885次动脉血气测量。90例（20.8%）患者在入住PICU的28天内死亡。观察到SHG和HL对预后有显著的相互作用效应（p<0.05）。在非HL组中，SHG不是28天死亡率的独立预测因素（p=0.656），并且与28天无呼吸机天数（p=0.916）或28天无ICU天数（p=0.914）均无相关性。相比之下，在HL组中，SHG与28天死亡率独立相关（OR 3.55，95%CI 1.62~7.80，p=0.002），并且与28天无呼吸机天数减少5.04天（p=0.003）和28天无ICU天数减少4.10天（p=0.004）相关。
HL可能调节儿科危重症患者中SHG与不良预后之间的相关性。SHG与HL并存与不良预后相关，而单纯SHG与不良预后无关。
