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Organ dysfunction is associated with hyperglycemia in critically ill children

Ursula G Kyle1, Jorge A Coss Bu, Curtis E Kennedy

  • 1Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, WT6-006, Houston, Texas 77030, USA. ukyle@bcm.tmc.edu

Intensive Care Medicine
|November 3, 2009
PubMed

Insights

Critically ill children with organ dysfunction were more likely to experience prolonged hyperglycemia. While hyperglycemia trended towards increased mortality, hypoglycemia was not associated with mortality in this study.

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Clinical Research

Background:

  • Hyperglycemia is common in critically ill children and may be associated with adverse outcomes.
  • Intravenous insulin is frequently used to manage hyperglycemia in pediatric intensive care units (PICUs).

Purpose of the Study:

  • To investigate the association between the degree of organ dysfunction and hyperglycemia in critically ill children receiving intravenous insulin therapy.
  • To explore the relationship between hyperglycemia, hypoglycemia, and mortality in this patient population.

Main Methods:

  • Retrospective cohort study of 110 patients admitted to a university hospital PICU.
  • Data collected on hyperglycemia duration, hypoglycemia, organ dysfunction (per International Pediatric Sepsis Consensus Conference criteria), and mortality.
  • Logistic regression models adjusted for confounding variables (age, gender, PRISM score, vasopressors, steroids).

Main Results:

  • Organ dysfunction (≥3 vs. <3 organs) was significantly associated with prolonged hyperglycemia (≥24 hours) (OR 6.1, p=0.004).
  • Hyperglycemia showed a trend towards association with mortality (OR 3.2, p=0.079).
  • Hypoglycemia was not significantly associated with mortality after adjustment for confounders.

Conclusions:

  • Prolonged hyperglycemia is significantly associated with increased organ dysfunction in critically ill children.
  • Hyperglycemia may be a risk factor for mortality in this population, though further research is needed.
  • Hypoglycemia does not appear to be associated with mortality in critically ill children receiving insulin therapy.
Abstract

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