Abstract
Objective
To determine the association between organ dysfunction and hyperglycemia in critically ill children receiving intravenous insulin.
Design
Retrospective chart review (cohort study).
Setting
Pediatric intensive care unit in a university hospital.
Patients
n = 110 patients; inclusion criteria: ICU hospitalization from May 2005 to May 2006; insulin drip to manage hyperglycemia. Exclusion criteria: insulin drip <48 h; diabetic patients.
Measurements
Duration of hyperglycemia: sum of hours of hyperglycemia (≥126 mg/dl). Hypoglycemia (blood glucose <40 mg/dl). Organ dysfunction was determined per International Pediatric Sepsis Consensus Conference criteria. Multiple logistic regression models determined the association between ≥3 compared to <3 organ dysfunctions and hyperglycemia, hypoglycemia, and mortality, after adjustment for confounding variables (age, gender, PRISM score, vasopressors, steroids).
Main results
Organ dysfunction ≥3 compared to <3 after adjustment for confounders was associated with intermittent hyperglycemia of ≥24 h (OR 6.1, CI 1.8–21.2; p = 0.004). Hyperglycemia trended towards significance with mortality [3.2 (CI 0.9–11.6, p = 0.079)]. Hypoglycemia, after adjusting for the above, was not associated with mortality.
Conclusions
Organ dysfunction (≥3 versus <3) was significantly associated with hyperglycemia for ≥24 h and hypoglycemia. Hyperglycemia trended toward significance with mortality in critically ill children. There was no association between hypoglycemia and mortality.
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Kyle, U.G., Coss Bu, J.A., Kennedy, C.E. et al. Organ dysfunction is associated with hyperglycemia in critically ill children. Intensive Care Med 36, 312–320 (2010). https://doi.org/10.1007/s00134-009-1703-1
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DOI: https://doi.org/10.1007/s00134-009-1703-1