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Validation of the Glycemic Stress Index in Pediatric Neurosurgical Intensive Care
Marco Piastra1, Alessandro Pizza2, Federica Tosi1,3
1Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.
Insights
The Glycemic Stress Index (GSI) effectively predicts longer pediatric intensive care unit (PICU) stays in children undergoing neurosurgery. This metabolic index, combining blood sugar levels and surgery duration, offers valuable insights for patient outcomes.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Critical Care Medicine
- Neurosurgery
Background:
- Hyperglycemia, both in degree and duration, is linked to adverse outcomes in pediatric anesthesia and critically ill children.
- The Glycemic Stress Index (GSI) was developed by combining intraoperative glycemic variations and surgery length to quantify metabolic glucose-related stress.
Purpose of the Study:
- To validate the GSI's predictive capability for pediatric intensive care unit (PICU) length of stay.
- To assess GSI in a pediatric population undergoing diverse major neurosurgical procedures.
Main Methods:
- 352 pediatric patients undergoing craniotomy were enrolled.
- Intraoperative blood loss was quantified using estimated red cell volume loss ratio.
- Receiver Operating Characteristic (ROC) analysis was employed to evaluate GSI's accuracy in predicting PICU stays exceeding 100 or 200 hours.
Main Results:
- The mean PICU stay was 35 hours.
- A significant direct correlation was found between GSI and PICU length of stay.
- GSI demonstrated an Area Under the ROC Curve (AUC) of 0.74 for predicting >200 hours PICU stay (p=0.03) and 0.67 for >100 hours (p=0.01).
Conclusions:
- The GSI is a significant predictor of prolonged PICU stays in children following major neurosurgery.
- The GSI proved more accurate in predicting extended PICU stays (>200 hours).
Background:
Studies have suggested that both the degree and the duration of hyperglycemia are independent risk factors for adverse outcome both in pediatric anesthesia and in critically ill children. In a recent paper, we combined intraoperative glycemic variations and length of surgery creating a metabolic glucose-related stress index called "Glycemic Stress Index" (GSI).
Aim:
To validate GSI for predicting PICU stay in a population of children undergoing different major neurosurgical procedures.
Methods:
A total of 352 patients with craniotomy were enrolled. Basic clinical data and PICU length of stay were recorded real time. Intraoperative blood loss has been determined considering the estimated red cell volume loss ratio. GSI was calculated and subjected to ROC analysis having as targets PICU length of stay >100 or >200 h.
Results:
The overall mean PICU stay was 35 h. Correlation analysis confirmed a low but highly significant direct correlation between GSI and PICU length of stay. ROC analysis showed an area under the ROC curve (AUC) of 0.74 (p = 0.03) for GSI to predict PICU stay >200 h and an AUC of 0.67 (p = 0.01) to predict PICU stay >100 h. Best predictive cutoff values were 4.5 and 3.9, for PICU stay >200 and >100 h, respectively. Overall accuracy for the test is higher in predicting PICU stay >200 h.
Conclusions:
GSI significantly predicts prolonged PICU stay after major neurosurgery in a mixed population of children affected by different neurosurgical conditions.
