Early metabolic derangements and unfavorable outcomes in pediatric traumatic brain injury: a retrospective multi-center cohort study

作者全名："Yao, Sarah; Chong, Shu-Ling; Allen, John Carson; Dang, Hongxing; Ming, Meixiu; Chan, Lawrence C. N.; Gan, Chin Seng; Ji, Jian; Fan, Lijia; Kurosawa, Hiroshi; Lee, Jan Hau"

作者地址："[Yao, Sarah; Chong, Shu-Ling] KK Womens & Childrens Hosp, Dept Emergency Med, Singapore, Singapore; [Chong, Shu-Ling] Duke NUS Med Sch, Singapore, Singapore; [Allen, John Carson] Duke NUS, Ctr Quantitat Med, Singapore, Singapore; [Dang, Hongxing] Chongqing Med Univ, Dept Pediat Intens Care Unit, Childrens Hosp, Chongqing, Peoples R China; [Ming, Meixiu] Fudan Univ, Dept Pediat Intens Care Unit, Childrens Hosp, Shanghai, Peoples R China; [Chan, Lawrence C. N.] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Pediat, Hong Kong, Peoples R China; [Gan, Chin Seng] Univ Malaya, Dept Pediat, Med Ctr, Kuala Lumpur, Malaysia; [Ji, Jian] Capital Med Univ, Beijing Childrens Hosp, Dept Pediat Intens Care Unit, Beijing, Peoples R China; [Fan, Lijia] Khoo Teck Puat Natl Univ, Natl Univ Hosp, Childrens Med Inst, Singapore, Singapore; [Fan, Lijia] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Pediat, Singapore, Singapore; [Kurosawa, Hiroshi] Hyogo Prefectural Kobe Childrens Hosp, Dept Pediat Crit Care Med, Kobe, Japan; [Lee, Jan Hau] KK Womens & Childrens Hosp, Childrens Intens Care Unit, Singapore, Singapore"

通信作者："Chong, SL (通讯作者)，KK Womens & Childrens Hosp, 100 Bukit Timah Rd, Singapore, Singapore."

来源：TRANSLATIONAL PEDIATRICS

ESI学科分类：　

WOS号：WOS:000948473100001

JCR分区：Q2

影响因子：1.5

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Hyperglycaemia; traumatic brain injury (TBI); neurological outcome

摘要："Background: To study the association in moderate and severe pediatric traumatic brain injury (TBI) between hyperglycemia, hyperlactatemia, acidosis and unfavorable outcome, as assessed by Pediatric Cerebral Performance Category (PCPC) on discharge from the pediatric intensive care unit (PICU). Methods: Children <16 years old with TBI and Glasgow Coma Scale (GCS) <= 13 in an Asian multi-center PICU TBI cohort from January 2014 to October 2017 were included in this study. We defined unfavorable outcome as PCPC >= 3-moderate disability, severe disability, vegetative state, and death. We performed logistic regression to investigate the association between metabolic changes with unfavorable outcome. We divided hyperglycemia (glucose >11.1 mmol/L) during PICU admission into early-onset (within 24 h), late onset (beyond 48 h) and persistent (throughout first 72 h). Results: Among the 305 children analyzed, 136 (44.6%) had unfavorable outcome. Children with unfavorable outcome were more likely to have early hyperglycemia (75/136, 55.1% vs. 33/169, 19.5%; P<0.001), high lactate levels >2.0 mmol/L (74/136, 54.4% vs. 56/169, 32.5%; P<0.001) and initial acidosis (85/136, 62.5% vs. 78/169, 56.1%; P=0.003) compared to those with favorable outcome. After adjusting for gender, GCS <= 8 and presence of polytrauma, early hyperglycemia [adjusted odds ratio (aOR) =3.68, 95% CI: 2.12-6.39, P<0.001] and late hyperglycemia (aOR =13.30, 95% CI: 1.64-107.8, P=0.015] were independently associated with unfavorable outcome. All children with persistent hyperglycemia died. Conclusions: We described unfavorable outcome in pediatric TBI especially with persistent hyperglycemia. Future trials should investigate the causal relationship between glycemic trends, early intervention and outcome in this cohort."

基金机构：SingHealth Foundation Research Grant [SHF/FG670P/2017]

基金资助正文：Acknowledgments Funding: This study was funded by the SingHealth Foundation Research Grant (No. SHF/FG670P/2017) .