血糖变异系数和SNAPPE-II与危重新生儿预后的相关性

doi:10.12372/jcp.2023.22e0086

Abstract

Abstract:

Objective To explore the association of coefficient of glycemic variation (CV) and score for neonatal acute physiology with perinatal extension-Ⅱ (SNAPPE-Ⅱ) with prognosis in critically ill neonates. Methods The clinical data of critically ill neonates admitted to the neonatal intensive care unit (NICU) from August 2018 to September 2020 were retrospectively analyzed. According to the prognosis, they were divided into death group and survival group, and the difference of clinical features between the two groups was compared. Binary logistic regression model was used to analyze the risk factors of poor prognosis in critically ill neonates. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of CV and SNAPPE-Ⅱ in poor prognosis of critically ill neonates. Results A total of 385 critically ill newborns were included, including 228 boys and 157 girls. The median age of admission was 1.0 (1.0-24.0) hours, the mean gestational age was (35.3±4.1) weeks, and the mean weight was (2456.6±860.3) grams. There were 85 hypoglycemic and 115 hyperglycemic patients. There were 80 patients in the death group, and the median time from NICU admission to death were 5.0 (2.0-10.3) days. Binary logistic regression analysis showed that CV, SNAPPE-Ⅱ, gestational age, weight, the main diagnosis of pulmonary hemorrhage and neonatal sepsis were correlated with death of critically ill neonates (P<0.05). The area under curve (AUC) of CV predicting death of critically ill neonates was 0.72, and the AUC of SNAPPE-Ⅱwas 0.85. When CV≥0.31, the sensitivity and specificity for the diagnosis of critical neonatal death were 0.75 and 0.59. When SNAPPE-Ⅱ≥18.50, the sensitivity and specificity for the diagnosis of critical neonatal death were 0.68 and 0.93. Conclusions Both CV and SNAPPE-Ⅱ have certain predictive values for the poor prognosis of critically ill neonates.

Key words: critically ill neonate, coefficient of glycemic variation, score for neonatal acute physiology with perinatal extension-Ⅱ, prognosis

XIANG Chao, ZHANG Rong, KANG Lan, LEI Xiaoping, LIU Xingqing, DONG Wenbin. Association of coefficient of glycemic variation and SNAPPE-Ⅱ with prognosis in critically ill neonates[J].Journal of Clinical Pediatrics, 2023, 41(6): 430-435.

Figures/Tables 4

References 31.

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项目	存活组(n=305)	死亡组(n=80)	统计量	P
男性[n(%)]	182(59.7)	46(57.5)	χ²=0.12	0.725
胎龄(x±s)/周	35.8±3.6	33.4±5.2	t=3.86	<0.001
体质量(x±s)/g	2555.2±796.8	2080.7±986.7	t=3.97	<0.001
CV[M(P₂₅~P₇₅)]	0.27(0.17~0.43)	0.41(0.31~0.64)	Z=5.94	<0.001
中位血糖[M(P₂₅~P₇₅)]/mmol·L^-1	4.68(4.17~5.30)	5.51(4.31~7.02)	Z=4.26	<0.001
初始血糖[M(P₂₅~P₇₅)]/mmol·L^-1	3.40(2.70~4.40)	3.60(2.38~6.05)	Z=1.95	0.052
低血糖[n(%)]	60(19.7)	25(31.2)	χ²=4.94	0.026
高血糖[n(%)]	62(20.3)	53(66.2)	χ²=63.80	<0.001
SNAPPE-Ⅱ[M(P₂₅~P₇₅)]	0.0(0.0~7.0)	29.5(8.5~44.0)	Z=10.46	<0.001
住院或死亡天数[M(P₂₅~P₇₅)]/d	9.0(6.0~15.0)	5.0(2.0~10.3)	Z=5.68	<0.001
机械通气天数[M(P₂₅~P₇₅)]/d	0.0(0.0~0.0)	2.0(0.0~5.0)	Z=13.81	<0.001
入院年龄[M(P₂₅~P₇₅)]/h	1.0(1.0~24.0)	3.0(1.0~14.0)	Z=3.40	0.001
妊娠期糖尿病[n(%)]	37(12.1)	7(8.8)	χ²=0.72	0.398
绒毛膜羊膜炎[n(%)]	14(4.6)	7(8.8)	χ²=1.40	0.237
主要诊断或死亡主要诊断
NRDS[n(%)]	153(50.2)	31(38.8)	χ²=3.31	0.069
新生儿窒息[n(%)]	59(19.3)	21(26.2)	χ²=1.84	0.175
新生儿败血症[n(%)]	42(13.8)	27(33.8)	χ²=17.20	<0.001
肺出血[n(%)]	3(1.0)	13(16.2)	χ²=33.35	<0.001
颅内出血[n(%)]	7(2.3)	3(3.8)	χ²=0.11	0.739
坏死性小肠结肠炎[n(%)]	8(2.6)	6(7.5)	χ²=3.02	0.082

变量	偏回归系数	标准误	χ²值	P	OR(95%CI)
截距	6.81	3.50	3.79	0.052	-
CV	2.00	1.00	4.01	0.045	7.36(1.04~51.96)
SNAPPE- II	0.09	0.01	46.23	<0.001	1.10(1.07~1.13)
胎龄	-0.25	0.11	5.18	0.023	0.78(0.63~0.97)
体质量	-0.00	0.00	3.89	0.049	1.00(1.00~1.00)
肺出血	2.90	0.97	8.96	0.003	18.09(2.72~120.47)
颅内出血	-0.43	1.08	0.16	0.689	0.65(0.08~5.36)
坏死性小肠结肠炎	0.95	0.69	1.89	0.169	2.57(0.67~9.90)
NRDS	-1.01	1.22	0.68	0.410	0.37(0.03~4.02)
新生儿窒息	1.97	1.09	3.29	0.070	7.17(0.85~60.25)
新生儿败血症	2.77	1.09	6.43	0.011	15.95(1.87~135.67)

变量	截断值	AUC(95%CI)	灵敏度	特异度	阳性预测值	阴性预测值
CV	0.31	0.72(0.66~0.78)	0.75	0.59	0.32	0.90
SNAPPE- II	18.50	0.85(0.79~0.90)	0.68	0.93	0.72	0.92

Association of coefficient of glycemic variation and SNAPPE-Ⅱ with prognosis in critically ill neonates

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