摘要
Abstract
Objective The value of different blood glycaemic variability (GV) indices to predict outcomes was studied in critically ill Children.Methods The retrospective study was conducted in Critical Care Medicine,Children's Hospital of Chongqing Medical University from January 2016 to December 2016.The included patients were divided into death group and survival group,by comparing the baseline characteristics of study and blood glucose concentration at admission (GLUAdm),average blood glucose (GLUAve),incidence of hyperglycemia,incidence of hypoglycemia,standard deviation (GLUSD),coefficient of variation (GLUCV),mean amplitude of glycaemic excursion(MAGE),and the glycaemic lability index(GLI).It was sought whether there were statistical differences among the 2 groups,and the correlation between different blood glucose indices and PRISM-Ⅲ score was analyzed.ROC(Receiver operating curve) was drawn to evaluate predictive values of different indicators.The best indicator to assess GV was looked for and then the logistic regression analyses were performed to assess the association between GV and ICU mortality.The cases were stratified according to the GLI.Results ① The length of stay,invasive mechanical ventilation,PRISM-Ⅲ score,SD,CV,MAGE,GLI and AVE showed a significant statistical difference between survival group and death group(P＜0.05).② 72 h SD,MAGE,GLI,AVE and PRISM-Ⅲ score had significantly positive correlation (correlation coefficient =0.202,0.204,0.335,0.281,P＜0.05).③ The area under the curve(AUC) of GLI(0.687,95％CI:0.611-0.708,P=0.001) was superior to AVE(0.624,95％CI:0.539-0.708,P=0.003),SD(0.654,95％CI:0.577-0.730,P＜0.001),CV (0.630,95％CI:0.552-0.708,P =0.002) and MAGE (0.605,95％ CI:0.525-0.686,P =0.012) under the determination of ROC respectivel.④ Multivariate logistic regression analysis showed that length of stay,invasive mechanical ventilation,PRISM-Ⅲ score and GLI were independently associated with mortality.⑤ With the GLI increased,the 28-day mortality and PRISM-Ⅲ score between subgroup Q3 (GLI=1.00-3.13 mmol2 · h-1 · d-1) and subgroup Q4 (GLI =3.13～ 12.96 mmol2 · h-1 · d-1) showed statistical difference (P＜0.05),therefore,the GLI below subgroup Q3 should be controlled.Conclusion GV was significantly associated with ICU mortality,the GLI had the greater superiority in predicting outcome,to control the GLI below3.13 mmol2 · h-1 · d-1 may be acceptable in critically ill children.关键词
血糖波动/危重患儿/预后Key words
Glycemic variability/Critically ill children/Prognosis
