Analysis of related factors for hyperamylasemia in critically ill children

Objective To analyze the clinical features of the hyperamylasemia in critically ill children and investigate the related risk factors in order to provide the basis for prevention and treatment. Methods A total of 1036 critically ill children admitted in pediatric intensive care unit （PICU）from April,2011 to Oct,2012 were studied.They were divided into the high amylase group （n=82）and the normal group （n=954）.According to the outcomes,the high amylase group was divided into survival group （n=61 ） and death group （n =21 ）.The related risk factors of the occurrence and outcome of hyperamylasemia were analyzed by univariate and multivariate Logistic regression.Results There were statistically significant differences in rates of coagulation disorders, convulsions, disturbance of consciousness,pediatric critical illness score （PCIS）≤80,multiple organ dysfunction （MODS）≥3, sepsis,shock,and lactic acid （LA）,procalcitonin （PCT）,blood glucose （BG）between the high amylase group and the normal group （P〈0.05 ）.The differences in the rates of coagulation disorders,convulsions, mechanical ventilation,PCIS≤80,MODS≥3,and LA,PCT,oxygenation index,albumin,C-peptide,BG were statistically significant between the survival group and the death group （P 〈0.05 ）.Multivariate Logistic regression analysis showed that the risk factors of the hyperamylasemia’s occurrence were LA,PCT, BG,PCIS〈80,MODS〉3.Adjusted ORs confidence intervals of them were 1.662 （1.236-2.234）,1.042 （1.025-1.060）,1.612 （1.411-1.843）,3.219 （1.311-7.905）,3.411 （1.370-8.494）,respectively. The hyperamylasemia’s prognostic risk factors were PCT,C-peptide,PCIS ≤80,MODS 〉3,shock. Adjusted ORs confidence intervals of them were 1.066（1.021-1.113）,1.437（1.017 -2.030）,16.137 （1.876-138.836）,10.437（1.528-71.925）,20.928（1.938-226.009）,respectively.Conclusions The severity of the disease,the levels of LA,PCT,BG in critically ill children were positively correlated to the occurrence of hyperamylasemia.The severity of the disease,the incidence of organ failures,the levels of PCT,C-peptide combined shock in children with hyperamylasemia were positively correlated to the prognosis of hyperamylasemia. Key words: Hyperamylasemia; Risk factors; Children; Critically ill; Prognosis; Sepsis; Hyperglycemia; Pancreatic injury