| Objective To examine the incidence of asymptomatic hyperamylasemia in PICU, to understand the clinical, biochemical, treatment and prognosis features of PICU patients with hyperamylasemia, thus make a preliminary study on shock/MODS associated with the clinical features of hyperamylasemia, the clinical significance of critically ill children with elevated serum amylase levels and the influencing factors associated with 3 times elevated serum amylase in PICU patients and prognosis in PICU patients with hyperamylasemia.Methods 437 consecutive PICU admissions during the study period of November 1st, 2009 to April 30th,2010 at Hunan Children's Hospital were enrolled in the study. Patients with acute pancreatitis, a history of benign and malignant pancreatic diseases were excluded. The clinical data were collected systematically and prospectively. Serum amylase (SAMY) were measured by dynamic monitoring and PCIS at 24h admission, APACHEⅡ, SOFA and SAPSⅡscores were evaluated in all patients.Results Hyperamylasemia was present in 56.29% of PICU patients. The PCIS score was 85.32±7.65 points on average among the 246 PICU patients with hyperamylasemia. SAMY in 70 cases were higher than 3 times UNL, accounting for 28.46%. Type B ultrasonic showed that 105 cases (68.18%) showed abnormal thickness of pancreas according to the standard value. 32 cases were cured (13.01%), 162 were improved (65.85%) and 52 were dead (21.14%). As the number of depleted organs increased, or shock/MODS occurred, the level of 24h SAMY was more higher and the proportion of 3 times UNL cases were larger. PCIS in SAMY level normal group, mild elevated group and≥3 times UNL group were 86.27±6.87,86.62±6.68,82.03±8.90 on average, respectively, the difference between the three groups was significant(F=11.2784 ,P<0.0001). The incidences of convulsion, consciousness disturbance, acidemia, stress ulcer, coagulation disorders, shock, MODS and hypocalcemia in≥3 times UNL group were much significantly higher than normal group and mild elevated group (P<0.05). The levels of K+ and Ca2 + were decreased by the elevated SAMY level, while the blood glucose level, UAMY level, LPS level, the abnormal rate of hypoalbuminemia and abnomal rate of high level of WBC, PCT, BUN, Cr, LDH were also increased. The abnormal thickness rate of pancreas in the three groups were 36.73%,67.26%,70.73%, respectively. The turnover rate and mortality rate in≥3 times UNL group were significantly higher than normal group and mild elevated group. As the SAMY level elevated, the admission and the largest APACHEⅡ,SAPSⅡ,SOFA scores were higher, and the accumulated survival rate of hospital stay was decreased. PCIS≤80 point, age, convulsion, coagulation disorders, elevated PCT level and abnormal thickness of pancreas were the risk factors associated with 3 times elevated serum amylase in PICU patients, OR were 2.352(95%CI 1.210~4.570), 1.175(95%CI 1.077~1.283), 2.215(95%CI 1.210~4.055), 3.564(95%CI 1.485~8.552), 2.082(95%CI 1.102~3.937), 2.317(95%CI 1.264~4.249), respectively. APACHEⅡ, SOFA scores, utilization of mechanical ventilation and NaHCO3 were the risk factors associated with prognosis in PICU patients with hyperamylasemia, OR were 1.127(OR95%CI 1.027~1.237), 1.523(OR95%CI 1.179~1.968), 7.284(OR95%CI 2.495~21.266), 3.468(OR95%CI 1.170~10.280) , respectively.Conclusion Hyperamylasemia was very common in PICU patients, the relationship between shock/MODS and critical level, changes of pancreatic enzymes and prognosis was closely. As the serum amylase level elevated, particularly, 3 times elevated or more, the critical level and mortality of PICU patients were gradually increased, and the prognosis became worse. |
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