Early Plasma Osmolality Levels and Clinical Outcomes in Children Admitted to the Pediatric Intensive Care Unit: A Single-Center Cohort Study.

Huabin Wang,Chun Chen,Ping Jin,Chao Lin,Huan Li,Zhongyuan He,Jiahong Li

doi:10.3389/fped.2021.745204

Abstract

Objective: Identifying high-risk children with a poor prognosis in pediatric intensive care units (PICUs) is critical. The aim of this study was to assess the predictive value of early plasma osmolality levels in determining the clinical outcomes of children in PICUs.Methods: We retrospectively assessed critically ill children in a pediatric intensive care database. The locally weighted-regression scatter-plot smoothing (LOWESS) method was used to explore the approximate relationship between plasma osmolality and in-hospital mortality. Linear spline functions and stepwise expansion models were applied in conjunction with a multivariate logistic regression to further analyze this relationship. A subgroup analysis by age and complications was performed.Results: In total, 5,620 pediatric patients were included in this study. An approximately “U”-shaped relationship between plasma osmolality and mortality was detected using LOWESS. In the logistic regression model using a linear spline function, plasma osmolality ≥ 290 mmol/L was significantly associated with in-hospital mortality [odds ratio (OR) 1.020, 95% confidence interval (CI) 1.010–1.031], while plasma osmolality <290 mmol/L was not significantly associated with in-hospital mortality (OR 0.990, 95% CI 0.966–1.014). In the logistic regression model with plasma osmolality as a tri-categorical variable, only high osmolality was significantly associated with in-hospital mortality (OR 1.90, 95% CI 1.38–2.64), whereas low osmolality was not associated with in-hospital mortality (OR 1.28, 95% CI 0.84–1.94). The interactions between plasma osmolality and age or complications were not significant.Conclusion: High osmolality, rather than low osmolality, can predict a poor prognosis in children in PICUs.

Highlights

In recent years, the mortality rate of critically ill children has shown a downward trend due to advancements in medical technology, the overall level is still quite high, especially among children aged under 5 years [1]
In the logistic regression model using a linear spline function, plasma osmolality ≥ 290 mmol/L was significantly associated with in-hospital mortality [odds ratio (OR) 1.020, 95% confidence interval (CI) 1.010–1.031], while plasma osmolality
In the logistic regression model with plasma osmolality as a tri-categorical variable, only high osmolality was significantly associated with in-hospital mortality, whereas low osmolality was not associated with in-hospital mortality

Summary

Introduction

The mortality rate of critically ill children has shown a downward trend due to advancements in medical technology, the overall level is still quite high, especially among children aged under 5 years [1]. Due to the complex and rapidly evolving condition of patients in pediatric intensive care units (PICUs), symptoms are often atypical, may change or progress at any time and can be life-threatening. The early identification of children whose condition may worsen or progress and providing timely interventions to these individuals are essential. Plasma osmolality refers to the amount of molecules (mg) per kilogram of water and is clinically expressed in units of mOsm/(kg·H2O) or mmol/L. Previous studies have shown that plasma osmolality is associated with the prognosis of patients with heart failure [3, 4], myocardial infarction [5, 6], and diabetic ketoacidosis [7], patients undergoing hemodialysis [8], elderly patients [9], and patients in the emergency room [10, 11]

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Discussion

Conclusion