Association of Hyperglycemia, Glucocorticoids, and Insulin Use with Morbidity and Mortality in the Pediatric Intensive Care Unit

Abstract

Background: Studies of pediatric intensive care unit (PICU) patients have shown a significant association of morbidity and mortality with hyperglycemia. We retrospectively evaluated the degree of hyperglycemia as well as its correlation with glucocorticoid and insulin use and assessed its association with hospital length of stay (LOS) and mortality. This study preceded the initiation of a standard glycemic control protocol. Methods: We examined medical records at Kosair Children's Hospital for all PICU admissions from 2008 of patients without diabetes mellitus. Critical illness hyperglycemia (CIH) was defined by having three or more peak glucose values greater than thresholds of 110, 140, 180, and 200 mg/dl. These patients were evaluated for glucocorticoid, insulin use, and outcome measures. Results: We evaluated the eligible 1173 admissions, where 10.5% of these patients reached the highest threshold (200 mg/dl) of CIH. Glucocorticoids were used in 43% of these patients, with dexamethasone being the most common (58%). There was a significant correlation between glucocorticoids and higher peak glucose values, where 81% of the patients who were above the 200 mg/dl cutoff level were treated with glucocorticoids. Only 36.8% in that group were also treated with insulin. Patients at the 200 mg/dl cutoff had the highest median PICU and total hospital length of stays (4 and 10 days, respectfully). Mortality was associated with increasing glucose levels, reaching 18.7% among patients above the 200 mg/dl cutoff. Conclusion: Hyperglycemia was prevalent in the PICU and was associated with increased morbidity, as characterized by increased LOS and increased mortality. Glucocorticoid use was prevalent among patients exhibiting hyperglycemia. Insulin use was uncommon.

U-shaped relationship between early blood glucose and mortality in critically ill children

“…To evaluate the relationship between early blood glucose concentrations and PICU mortality and to define a ‘safe range’ for blood glucose concentrations during the first 24 h after PICU admission, both the initial admission glucose value and the mean glucose value over the first 24 h after PICU admission were analyzed. The initial admission glucose values and the mean glucose values over the first 24 h of admission were divided into 6 strata based on cutoff values of 65, 90, 110, 140, and 200 mg/dL (3.6, 5.0, 6.1, 7.8, and 11.1 mmol/L), which were established according to clinical observational and interventional pediatric studies [ 16 , 19 , 22 ]. PICU mortality was calculated for each stratum, and the stratum with the lowest mortality incidence was used as a reference.…”

Short Course of Systemic Corticosteroids in Wheezy Children: Still an Open Question

“…Changes in blood glucose levels were not significant, but there was one case of hyperglycemia (> 11.1 mmol/L) in the intervention group after the first day of treatment. More significant cases of hyperglycemia were observed in previous studies [20,21]. Systemic GCS administration should be considered as a risk factor for children with diabetes with hyperglycemia, even if prescribed as a short course.…”

Biochemistry in Intensive Care

“…Hyperglycaemia can worsen a hyperosmotic state such as uraemia and may predispose a patient to infection. Several studies in recent years have revealed an association with hyperglycaemia and increased morbidity and mortality in intensive care patients although there is still some disagreement on the degree of significance [67][68][69][70][71]. Hyperglycaemia in sepsis is also a poor predictor in noncritical-care hospitalised patients and there have been recent guidelines suggesting point-of-care glucose in all hyperglycaemic hospitalised patients, whether diabetic or not [70].…”