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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit.
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Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit.

机译：小儿重症监护病房中低血糖，高血糖和葡萄糖变异性与发病率和死亡的关联。

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OBJECTIVE: We evaluated retrospectively plasma glucose levels and the degree of hypoglycemia, hyperglycemia, and glucose variability in a PICU and then assessed their association with hospital length of stay and mortality rates. METHODS: Electronic medical records at the Packard Children's Hospital at Stanford University were reviewed retrospectively for all PICU admissions between March 1, 2003, and March 31, 2004. Patients with a known diagnosis of diabetes mellitus were excluded. The prevalence of hyperglycemia was defined with cutoff values of 110, 150, and 200 mg/dL. Hypoglycemia was defined as < or = 65 mg/dL. Glucose variability was assessed with a calculated glucose variability index. RESULTS: In 13 months, 1094 eligible admissions generated 18865 glucose values (median: 107 mg/dL; range: 13-1839 mg/dL). Patients in the highest maximal glucose quintile had a significantly longer median PICU length of stay, compared with those in the lowest quintile (7.5 days vs 1 day). Mortality rates increasedas patients' maximal glucose levels increased, reaching 15.2% among patients with the greatest degree of hyperglycemia. Hypoglycemia was also prevalent, with 18.6% of patients (182 of 980 patients) having minimal glucose levels of < or = 65 mg/dL. There was an increased median PICU length of stay (9.5 days vs 1 day) associated with glucose values in the lowest minimal quintile, compared with those in the highest quintile. Hypoglycemia was correlated with mortality rates; 16.5% of patients with glucose levels of < or = 65 mg/dL died. Glucose variability also was associated with increased length of stay and mortality rates. In multivariate logistic regression analyses, glucose variability, taken with hyperglycemia and hypoglycemia, showed the strongest association with mortality rates. CONCLUSIONS: Hyperglycemia and hypoglycemia were prevalent in the PICU. Hypoglycemia, hyperglycemia, and, in particular, increased glucose variability were associated with increased morbidity (length of stay) and mortality rates.
机译：目的：我们回顾性评估了PICU中的血浆葡萄糖水平以及低血糖，高血糖和葡萄糖变异性的程度，然后评估了它们与住院时间和死亡率的关系。方法：回顾性地回顾了斯坦福大学帕卡德儿童医院的电子病历，调查了2003年3月1日至2004年3月31日期间所有PICU入院的病例。排除了已知诊断为糖尿病的患者。高血糖的发生率定义为临界值110、150和200 mg / dL。低血糖症定义为<或= 65 mg / dL。用计算的葡萄糖变异性指数评估葡萄糖变异性。结果：在13个月中，有1094例合格入院患者产生了18865个葡萄糖值（中位数：107 mg / dL;范围：13-1839 mg / dL）。与最低的五分位数患者相比，最大的五分位数最高的患者的中位PICU住院时间明显更长（7.5天比1天）。死亡率随着患者最大葡萄糖水平的升高而增加，在高血糖程度最高的患者中，死亡率达到15.2％。低血糖症也很普遍，有18.6％的患者（980例患者中有182例）的最低血糖水平≤65 mg / dL。与最低的五分位数患者相比，最低的最低五分位数患者的中位PICU住院时间中位数增加（9.5天比1天），与血糖值相关。低血糖症与死亡率相关。血糖水平≤65 mg / dL的患者中有16.5％死亡。葡萄糖变异性也与住院时间和死亡率增加有关。在多因素logistic回归分析中，高血糖症和低血糖症患者的血糖变异性与死亡率具有最强的相关性。结论：PICU中普遍存在高血糖和低血糖症。低血糖，高血糖，尤其是葡萄糖变异性增加，与发病率（住院时间）和死亡率增加有关。

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