Impact Of Glycaemic Variabilityon Critically Ill Children

Objective:We compared the ability of different glycaemic variability(GV)indices to predict outcomes in critically ill Children;To look for the best indicator to assess GV and the effect of glycaemic variability on the prognosis by Ave tertiles.Methods:The retrospective study was conducted in intensive care unit,Children's Hospital of Chongqing Medical University from January2016 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(Adm),average glucose(Ave),incidence of hypoglycemia(V1),incidence of hypergly cemia(V2),standard deviation(SD),coefficient of variation(CV),mean amplitude of glycaemic excursion(MAGE)and the glycaemic lability index(GLI).we sought whether there were statistical differences among the2 groups,and analyzed the correlation between different blood glucose indices and PRISM-III score.ROC(Receiver operating curve)was drawn to evaluate predictive values of different indicators.To look for the bestindicator to assess GV and then performe the Logistic regression analyses to assess the association between GV and ICU mortality.The cases were stratified according to the GLI and average glucose.Results:1 The length of stay,invasive mechanical ventilation,PRISM-III score,SD,CV,MAGE and GLI showed a significantly statistical difference between Survival group and Death group(p<0.05).2SD,CV,MAGE,GLI,AVE and PRISM-III score had significantly positive correlation(correlation coefficient= r=0.284,0.246,0.265,0.404,0.218,p<0.05).3 The area under the curve(AUC)of GLI was superior to SD,CV and MAGE 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 Average glucose and glycaemic variability were stratified,The same level of blood glycaemic variability was different in different average glucose;The same average glucose,increased variability was associated with significantly increased mortality,Among patients with low average glucose group,those with higher variability had a significant increase in the mortality(p < 0.05),Patients with higher average glucose levels had an increase in their adjusted odds of death,but had a nonsignificant increase in the mortality(p >0.05).different groups,lower average glucose and higher glycaemic variability had the worst prognosis.Conclusion:Critically ill children with glycaemic variability areclosely associated with poor prognosis,the GLI has the greater superiority in predicting outcome,the glycaemic variability on the prognosis can be affected by the average glucose,and the conclusion of adult is that the highest average glucose and glycaemic variability group has worst prognosis,but this study shows that lowest average glucose and highest glycaemic variability group has worst prognosis for critically ill children.Therefore,it is necessary to avoid the occurrence of large glycaemic variability in children with hypoglycemia.