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Indian Pediatr 2009;46: 809-810 |
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Day 1 Blood Glucose and Outcome in Critically
Ill Children |
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Rakesh Lodha, Tsultem D Bhutia, SK Kabra and Anu Thukral
Department of Pediatrics, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi, India.
Email: [email protected]
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Abstract
We analyzed the association between the day 1 glucose
values in 209 children admitted to the PICU and the outcome (mortality).
58 (27.7%) children had hyperglycemia while 18 (8.6%) children had
hypoglycemia, on day 1 after admission. Hypoglycemia was associated with
higher mortality. This is contrary to the prevalent view supporting the
association of hyperglycemia with poor outcome in the critically ill
children.
Key words: Blood glucose, Child, Critically ill, Outcome.
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Hyperglycemia during critical illness is a fairly
common observation; the prevalence ranging from 15% to 86%(1-4). Studies
have suggested that hyperglycemia in critically ill children is associated
with increased mortality and length of stay(1-4). Some studies have
documented hypoglycemia in approximately 10% children(3,4). We undertook a
retrospective analysis of data of children admitted to our PICU to
evaluate association between abnormalities in blood glucose in first 24
hrs of admission with mortality. Hyperglycemia was defined as blood
glucose >126 mg/dL while hypoglycemia was defined as blood glucose <60
mg/dL(1).
Data for 209 (134 boys) children aged more than 1 month
age were analyzed. 48.8% of our patients were underweight (weight for age
£2
SD) and 46% had wasting (weight for height
£2
SD). In 37.2%, the primary indication of admission was severe
sepsis/septic shock; respiratory distress requiring ventilation accounted
for the second largest category (25.6%). 70 children died. 58 (27.7%)
children had hyperglycemia, while 18 (8.6%) children had hypoglycemia on
Day 1 of admission. Table I shows the characteristics of the
3 groups based on the blood glucose values on day 1. This suggests that
hypoglycemia is an important determinant of mortality in critically ill
children. On controlling for the severity of illness using PRISM or PIM2,
the association was no longer significant (P=0.68 and P=0.23,
respectively).
TABLE I
Characteristics of Study Subjects
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Hypoglycemia
(n = 18) |
Normoglycemia
(n = 133) |
Hyperglycemia
(n = 58) |
P value
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| Boys |
11 |
83 |
40 |
0.66 |
| Age (months), median (95% CI) |
14 (4, 36) |
18 (11, 27.9) |
24 (14, 46.7) |
0.74 |
| Infection at admission |
13 (72.2%) |
97 (72.9%) |
42 (72.4%) |
0.99 |
| PRISM, median (95% CI) |
25.5 (17.8, 40.9) |
14 (12.7, 15) |
19 (16, 22) |
0.34 |
| Probability of death using PIM2 score, median (95% CI) |
32.2% (8, 78.4) |
8% (7, 9.4%) |
13% (8, 26.6) |
0.89 |
| PICU stay (days), median (95% CI) |
2 (1, 11) |
4 (3, 5) |
3 (3, 5) |
0.32 |
| Survival |
6 (33.3%) |
97 (72.9%) |
36 (62.1%) |
0.003 |
Our observations suggest an association of hypoglycemia
with mortality while there was no such association between hyperglycemia
and mortality (P=0.13), which is at variance with most published
pediatric studies. Our results are similar to those reported by Klein,
et al.(5). They observed that controlling for disease severity,
hyperglycemia within 24 hours of PICU admission was not independently
associated with increased mechanical ventilation time, length of stay, or
mortality(5), though they used a cut off of 200 mg/dL for defining
hyperglycemia. Our study patients differ from those in other studies in
that we did not have post-surgical patients, while in others they
constituted a major proportion. Moreover, a considerable number of
children had associated malnutrition. The findings reported here should
serve as a caution to the prevalent view supporting the association of
hyperglycemia with poor outcome in the PICU.
References
1. Srinivasan V, Spinella PC, Drott HR, Roth CL,
Helfaer MA, Nadkarni V. Association of timing, duration, and intensity of
hyperglycemia with intensive care unit mortality in critically ill
children. Pediatr Crit Care Med 2004; 5: 329-336.
2. Faustino EV, Apkon M. Persistent hyperglycemia in
critically ill children. J Pediatr 2005; 146: 30-34.
3. Wintergerst KA, Buckingham B, Gandred L, Wong BJ,
Kach S, Wilson DM. Association of hypoglycemia, hyperglycemia and glucose
variability with morbidity and death in pediatric intensive care unit.
Pediatrics 2006; 118: 173-179.
4. Hirshberg E, Larsen G, Duker VD. Alteration in
glucose homeostasis in pediatric intensive care unit. Pediatr Crit Care
Med 2008; 9: 361-366.
5. Klein GW, Hojak JM, Schmeidler J, Rappaport R. Hyperglycemia and
outcome in pediatric intensive care unit. J Pediatr 2008; 153: 379-384.
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