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Impaired Pancreatic β-Cell Function in Critically Ill Children.

Shereen A Mohamed1, Nora E Badawi1, Hoiyda A AbdelRasol2

  • 1Pediatric Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.

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|April 19, 2021
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Summary

Critical illness hyperglycemia in pediatric intensive care units (PICU) is linked to pancreatic beta-cell dysfunction. This dysfunction significantly impacts patient morbidity and mortality, highlighting the need for further investigation and management strategies.

Keywords:
HOMA-βPRISM III scorehyperglycemiapediatric ICUβ cell dysfunction

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Area of Science:

  • Pediatric Endocrinology
  • Critical Care Medicine
  • Metabolic Disorders

Background:

  • Critical illness hyperglycemia (CIH) is a frequent complication in pediatric intensive care units (PICUs).
  • Key mechanisms include increased glucose production, insulin resistance (IR), and pancreatic beta-cell dysfunction.
  • Understanding beta-cell function is crucial for managing CIH and predicting outcomes.

Purpose of the Study:

  • To investigate pancreatic beta-cell function in pediatric patients experiencing critical illness.
  • To explore the relationship between beta-cell function and clinical/laboratory variables.
  • To determine the association between beta-cell function and intensive care unit (ICU) mortality.

Main Methods:

  • Prospective recruitment of 91 pediatric patients in the ICU.
  • Assessment of pancreatic beta-cell function using the homeostasis model assessment (HOMA)-beta.
  • Analysis of clinical data, laboratory markers (e.g., C-reactive protein), and ICU mortality.

Main Results:

  • Patients with HOMA-beta <40.0% exhibited higher PRISM III scores, elevated CRP, lower IR, and longer hospital stays.
  • Insulin resistance varied with beta-cell function: highest at 40-80% and intermediate at >80%.
  • ICU survivors demonstrated significantly better beta-cell function compared to non-survivors.

Conclusions:

  • Pancreatic beta-cell dysfunction is prevalent in critically ill children.
  • Impaired beta-cell function (HOMA-beta <80.0%) and higher PRISM III scores are significant predictors of ICU mortality.
  • Beta-cell dysfunction plays a critical role in the morbidity and mortality of pediatric ICU patients.