Investigation of the Relation Between Hyperglycemia andMorbidity andMortality Rates in Critically Ill Children inMarch 2013 to February 2014

Document Type : Original Article

Authors

1 Department of Nutrition, Faculty of Medicine,Mashhad University of Medical Sciences,Mashhad, IR Iran

2 Departement of Biology, Faculty of Sciences, Young Researchers and Elite Club, Islamic Azad University,Mashhad Branch,Mashhad, IR Iran

3 Neonatal Research Center, School of Medicine,Mashhad University of Medical Sciences,Mashhad, IR Iran

4 Fellowship of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine,Mashhad University of Medical Sciences,Mashhad, IR Iran

Abstract

Background: The purpose of this study is to determine the frequency of hyperglycemia in nondiabetic critically ill children and to investigate its relationship withmechanical ventilation, length of stay andmortality.
 
Methods: In this original retrospective study, data was (were) collected between 2013 and 2014 from the pediatric intensive care unit data base of Sheikh’s Children Hospital inMashhad, Iran (one hundred admitted children).
 
Results: From among 97 subjects, 49 subjects (50.5%) were hospitalized for more than 10 days, and the mean length of stay wa 14 days. The overall mortality rate was 16 subjects (16.5%) and frequency of hyperglycemia was 24 subjects (24.7%). The median fo blood glucose measurements was 100 mg/dl. Seventy three subjects (75.3%) had a mean blood glucose level in the normal range Overall, 18 subjects (18.6%) had at least one blood glucosemeasurement of 180mg/dL or higher. There was a significant association between hyperglycemia and mortality (P < 0.001). Linear regression analysis showed positive correlation between blood glucose level, length of stay and length of ventilation (P  0.001). The maximum serum glucose concentration positively correlated with duration of mechanical ventilation and length of stay (P < 0.001).
 
Conclusions: Our study found thatmaximumserumglucose concentration positively correlatedwith the duration of mechanica ventilation, length of stay, andmortality.

Keywords

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

  1. Kyle UG, Coss Bu JA, Kennedy CE, Jefferson LS. Organ dysfunction is associated with hyperglycemia in critically ill children. Intensive Care Med. 2010;36(2):312–20. doi: 10.1007/s00134-009-1703-1. [PubMed: 19882139].
  2. Klein GW, Hojsak JM, Schmeidler J, Rapaport R. Hyperglycemia and outcome in the pediatric intensive care unit. J Pediatr. 2008;153(3):379–84. doi: 10.1016/j.jpeds.2008.04.012. [PubMed: 18534209].
  3. Preissig CM, Rigby MR. A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: a survey on actual practice habits. Crit Care. 2010;14(1):R11. doi: 10.1186/cc8865. [PubMed: 20128893].
  4. Patki VK, Chougule SB. Hyperglycemia in critically ill children. Indian J Crit Care Med. 2014;18(1):8–13. doi: 10.4103/0972-5229.125427. [PubMed: 24550607].
  5. Poddar B. Treating hyperglycemia in the critically ill child: is there enough evidence?. Indian Pediatr. 2011;48(7):531–6. [PubMed: 21813922].
  6. Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. J Pediatr. 2005;146(1):30–4. doi: 10.1016/j.jpeds.2004.08.076. [PubMed: 15644818].
  7. Kao LS, Morris BH, Lally KP, Stewart CD, Huseby V, Kennedy KA. Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol. 2006;26(12):730–6. doi: 10.1038/sj.jp.7211593. [PubMed: 16929344].
  8. Hirshberg E, Lacroix J, Sward K, Willson D, Morris AH. Blood glucose control in critically ill adults and children: a survey on stated practice. Chest. 2008;133(6):1328–35. doi: 10.1378/chest.07-2702. [PubMed: 18339779].
  9. Nayak P, Lang H, Parslow R, Davies P, Morris K, U. K. Paediatric Intensive Care Society Study Group . Hyperglycemia and insulin therapy in the critically ill child. Pediatr Crit Care Med. 2009;10(3):303–5. doi: 10.1097/PCC.0b013e318198b012. [PubMed: 19307807].
  10. Hall NJ, Peters M, Eaton S, Pierro A. Hyperglycemia is associated with increased morbidity and mortality rates in neonates with necrotizing enterocolitis. J Pediatr Surg. 2004;39(6):898–901. [PubMed: 15185221] discussion 898-901.
  11. Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009;373(9663):547–56. doi: 10.1016/S0140-6736(09)60044-1. [PubMed: 19176240].
  12. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–82. doi: 10.1210/jcem.87.3.8341. [PubMed: 11889147].
  13. Preissig CM, Rigby MR. Pediatric critical illness hyperglycemia: risk factors associated with development and severity of hyperglycemia in critically ill children. J Pediatr. 2009;155(5):734–9. doi: 10.1016/j.jpeds.2009.05.007. [PubMed: 19628220].
  14. Yung M, Wilkins B, Norton L, Slater A, Paediatric Study G, et al. Glucose control, organ failure, and mortality in pediatric intensive care. Pediatr Crit Care Med. 2008;9(2):147–52. doi: 10.1097/PCC.0b013e3181668c22. [PubMed: 18477927].
  15. 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(4):329–36. [PubMed: 15215001].
  16. Preissig CM, Hansen I, Roerig PL, Rigby MR. A protocolized approach to identify and manage hyperglycemia in a pediatric critical care unit. Pediatr Crit Care Med. 2008;9(6):581–8. doi: 10.1097/PCC.0b013e31818d36cb. [PubMed: 18838924].
  17. Day KM, Haub N, Betts H, Inwald DP. Hyperglycemia is associated with morbidity in critically ill children with meningococcal sepsis. Pediatr Crit Care Med. 2008;9(6):636–40. doi: 10.1097/PCC.0b013e31818d350b. [PubMed: 18838926].
  18. Yates AR, Dyke P2, Taeed R, Hoffman TM, Hayes J, Feltes TF, et al. Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient. Pediatr Crit Care Med. 2006;7(4):351–5. doi: 10.1097/01.PCC.0000227755.96700.98. [PubMed: 16738506].
  19. Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics. 2006;118(1):173–9. doi: 10.1542/peds.2005-1819. [PubMed: 16818563].
Razavi International Journal of Medicine
Volume 4, Issue 4
October 2016

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