Arterial ketone body ratio for the assessment of the severity of illness in pediatric patients following cardiac surgery.
OBJECTIVE
The purpose of this study was to assess whether the arterial ketone body ratio (AKBR) can be effectively used to evaluate the severity of illness in children following cardiac surgery.


METHODS
AKBR was measured in 157 consecutive pediatric patients following heart surgery on the odd numbers of postoperative days. The relationship between AKBR and patient outcome was analyzed using the data of 141 patients with cardiopulmonary bypass.


RESULTS
Initial AKBR was frequently lower than 1.0, and this was associated with the increases in total ketone body counts. Insufficient glucose metabolism appeared to contribute to the low initial AKBR. As a result, the specificity of initial AKBR as a mortality predictor was lower than that of initial blood lactate. In the sequential analysis of AKBR for the 48 patients with PICU stay longer than 5 days, patients showing a sustained lower level <1.0 had significantly higher development of organ dysfunction (liver, heart) and greater mortality (56%).


CONCLUSIONS
Sustained postoperative decrease in AKBR <1.0 represents lethal outcome. The analysis of AKBR trend in combination with a measurement of blood lactate level in early postoperative period appears to be useful for the assessment of the severity of illness in pediatric patients following heart surgery.
Shime
N
N
Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ashida
H
H
Hiramatsu
N
N
Kageyama
K
K
Katoh
Y
Y
Hashimoto
S
S
Tanaka
Y
Y
D000293:Adolescent; D001158:Arteries; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007564:Japan; D007657:Ketone Bodies / Q000097:blood*; D019344:Lactic Acid / Q000097:blood; D011183:Postoperative Complications / Q000145:classification; D011336:Probability; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome
D007657:Ketone Bodies; D019344:Lactic Acid