title: Validation of the Glycemic Stress Index in Pediatric Neurosurgical Intensive Care.
abstract: 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).
  
  
  OBJECTIVE
  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.
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Piastra
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy. a.pizza87@gmail.com.
authors.forename: Alessandro
authors.identifier: http://orcid.org/0000-0002-3444-8335
authors.initials: A
authors.lastname: Pizza
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.|Pediatric NeuroAnesthesia, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Tosi
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.|Pediatric NeuroAnesthesia, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Mensi
authors.affiliation: Pediatric Neurosurgery, Department of Neuroscience, University Hospital "A. Gemelli", Catholic Universit Medical School, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Massimi
authors.affiliation: Plastic Surgery and Burn Unit, S. Eugenio Hospital, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Bellis
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.
authors.forename: Daniele G
authors.initials: DG
authors.lastname: Biasucci
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.
authors.forename: Ersilia
authors.initials: E
authors.lastname: Luca
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.affiliation: Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, University Hospital "A. Gemelli", Catholic University Medical School, Rome, Italy.|APHP, South Paris University Hospitals, Medical Center "A.Beclere", Paris, France.
authors.forename: Daniele
authors.initials: D
authors.lastname: De Luca
mesh_terms: D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000378:metabolism*; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000378:metabolism*; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000502:physiology*
chemical_list: D005947:Glucose
keywords: Hyperglycemia; Neurosurgery; Outcome; Pediatric intensive care unit; Pediatric intensive care unit stay; Postoperative care