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Glycemic Stress Index: Does It Correlate with the Intensive Care Length of Stay?

Mathieu Georges1, Thomas Engelhardt1, Pablo Ingelmo1

  • 1Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, QC H4A 3J1, Canada.

Children (Basel, Switzerland)
|February 25, 2023
PubMed

Insights

The Glycemic Stress Index (GSI) can predict longer intubation and Pediatric Intensive Care Unit (PICU) stays in infants after heart surgery. Preoperative fasting does not influence GSI, but a high GSI indicates a risk of metabolic complications.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Endocrinology

Background:

  • Postoperative hyperglycemia is a known risk factor for complications in adults, but its impact in pediatric cardiac surgery patients is less understood.
  • The Glycemic Stress Index (GSI) has shown promise in predicting extended Pediatric Intensive Care Unit (PICU) stays in neurosurgical patients.
  • Data on the influence of preoperative fasting on perioperative hyperglycemia in infants are limited.

Purpose of the Study:

  • To investigate the correlation between the Glycemic Stress Index (GSI) and the duration of intubation, PICU stay, and postoperative complications in infants undergoing elective open heart surgery.
  • To assess the relationship between preoperative fasting duration and GSI in this patient population.

Main Methods:

  • Retrospective chart review of 85 infants (≤ 6 months) undergoing elective open heart surgery.
  • Analysis of GSI values (thresholds of 3.9 and 4.5) for association with postoperative complications, including metabolic uncoupling, kidney injury, ECMO, and mortality.
  • Investigation of correlations between GSI, intubation duration, PICU stay, and fasting duration. Perioperative factors were also analyzed.

Main Results:

  • GSI demonstrated a significant correlation with the duration of intubation and PICU stay.
  • A GSI threshold of 4.5, but not 3.9, was associated with an increased incidence of metabolic uncoupling.
  • GSI was not found to be influenced by preoperative fasting duration.
  • Preoperative abnormal creatinine levels were linked to an increased risk of postoperative acute kidney injury.

Conclusions:

  • The Glycemic Stress Index (GSI) may serve as a valuable predictor for prolonged intubation, extended PICU stays, and metabolic derangements in infants undergoing cardiac surgery.
  • Preoperative fasting does not appear to significantly affect GSI in this cohort.
  • Further research into GSI's predictive capabilities in pediatric cardiac surgery is warranted.

Keywords:
Glycemic Stress IndexPICU length of staycongenital heart diseasepreoperative fasting

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