Sarah Yao
KK Women's and Children's Hospital
Singapore, Slovenia
Disclosure information not submitted.
Shu-Ling Chong, MBBS, MRCPCH, MCI, MPH
Clinical Associate Professor
KK Women's and Children's Hospital, Singapore
Disclosure information not submitted.
John Carson Allen, PhD
PhD
Centre for Quantitative Medicine, Duke-NUS, Singapore, Singapore
Disclosure information not submitted.
Hongxing Dang, MD
Dr
Children’s Hospital of Chongqing Medical University, United States
Disclosure information not submitted.
Meixiu Ming, MD
Doctor
Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China, China (People's Republic)
Disclosure information not submitted.
Lawrence Chan, FHKAM
Doctor
Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Disclosure information not submitted.
Chin Seng Gan, M PED
Doctor
Department of Pediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia, Malaysia
Disclosure information not submitted.
Jian Ji, MD
Doctor
Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, Beijing, China, China (People's Republic)
Disclosure information not submitted.
Li Jia Fan, MRCPCH
Doctor
Khoo Teck Puat National University Children’s Medical Institute, National University Hospital, Singapore, Singapore
Disclosure information not submitted.
Hiroshi Kurosawa, MD
Doctor
Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan, Japan
Disclosure information not submitted.
Lee Jan Hau, MBBS, MRCPCH, MCI (he/him/his)
KK Women's and Children's Hospital, Singapore
Singapore, Slovenia
Disclosure information not submitted.
Title: The Metabolic Journey in Pediatric Traumatic Brain Injury – A PACCMAN Analysis
Introduction: Children with moderate-to-severe traumatic brain injury (TBI) present with a profoundly hyper-metabolic state. We aimed to study the association between early hyperglycemia, hyperlactatemia and acidosis with poor outcome in this cohort; and to identify initial glycemic thresholds in prognosticating poor outcome.
Methods: We performed the analysis using a multicenter TBI study cohort from the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN). We included children < 16 years with TBI and Glasgow Coma Scale (GCS) ≤ 13 admitted to pediatric intensive care units from January 2014 - October 2017. We defined poor outcome as Pediatric Cerebral Performance Category (PCPC) ≥ 3 – moderate disability, severe disability, vegetative state and death. We performed logistic regression to investigate the association between early metabolic changes with poor outcome, and used Youden index to identify glycemic cut-off in determining poor outcome.
Results: 305 children [median age 4.2 years, interquartile range (IQR) 1.8 – 8.8] were studied. 136 (44.6%) patients had poor outcome. A greater proportion of children with poor outcome had initial hyperglycemia on admission (glucose >11.1mmol/L) compared to those with good outcome (57/136, 41.9% vs 19/169, 11.2%, p< 0.001). Median PCPC scores were worse in initially euglycemic children who developed hyperglycemia compared to those with initial hyperglycemia that resolved at 48-72 hours of admission [5.0 (5.0 – 5.5) vs 3.0 (2.0 – 5.0), p < 0.001]. We identified a glycemic threshold of 11.1mmol/L as predictive of poor outcome. Patients with poor outcome had higher median lactate levels (2.7 mmol/L, IQR 1.5 – 5.2, vs 1.9 mmol/L, IQR 1.2- 3.4, p< 0.001) and a greater proportion had initial acidosis (86/136, 62.5% vs 78/169, 56.1%, p = 0.002), compared to those with good outcome. After adjusting for gender, GCS < 8 and presence of polytrauma, only early hyperglycemia predicted for poor outcome [adjusted odds ratio (aOR) 4.13, 95% confidence interval 2.20– 7.78, p< 0.001]. Hyperlactatemia and acidosis were not independent predictors of poor outcome.
Conclusion: Early hyperglycemia is a significant and reliable predictor of poor outcome in pediatric TBI. A glycemic threshold of 11.1mmol/L is a plausible target for future trials to improve functional outcome in this cohort