Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children

Srinivasan, Vijay; Spinella, Philip C.; Drott, Henry R.; Roth, Carey; Helfaer, Mark A.; Nadkarni, Vinay

doi:10.1097/01.pcc.0000128607.68261.7c

Cited by 308 publications

(207 citation statements)

References 43 publications

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“…[10][11][12][13][14][15] Three retrospective studies have demonstrated that admission hyperglycemia is also a predictor of adverse outcomes in the pediatric intensive care unit. 20,22 Srinivasan and colleagues 22 demonstrated that 86% of patients in their pediatric intensive care unit had a glucose value >126 mg/dL at some point during their stay. In addition, they showed that duration of the hyperglycemia and peak glucose were also associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

“…We arbitrarily used 3 glucose cutoff values in this study (<120, 120-179, and >180 mg/dL). Although similar values have been used in inpatient diabetes studies, [20][21][22] there is no uniform definition of hyperglycemia in hospitalized patients, and the clinical significance of these cutoff values in pediatric population has not been determined. The study was conducted in a single institution in Atlanta, whose population and disease spectrum might be different from those at other pediatric institutions.…”

Section: Discussionmentioning

confidence: 99%

“…The few observational studies in critically ill children admitted to the pediatric ICU with severe brain injury or extensive burn injuries have shown a positive association between inpatient hyperglycemia and increased length of hospital and ICU stay and a higher risk of complication and mortality rates. [19][20][21][22][23] No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a general community pediatric hospital. Therefore, in this study we determined the prevalence of inpatient hyperglycemia and examined the impact of hyperglycemia on morbidity and mortality in children admitted to Hughes Spalding Children's Hospital, a large community hospital serving the inner city and indigent pediatric population in Atlanta, Georgia.…”

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confidence: 99%

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Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Inpatient hyperglycemia in adult patients with and without a history of diabetes is a predictor of poor clinical outcome. No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a community pediatric hospital.METHODS:The study was a retrospective observational cohort of pediatric patients admitted to a community children's hospital from January 2004 to August 2004. Medical records of 903 consecutive children admitted to critical and non–critical care areas were reviewed. Of them, 342 patients (38%) had no blood glucose measurements during their hospital stay. In the remaining patients, we determined the prevalence of hyperglycemia and examined the association of hyperglycemia with clinical outcome.RESULTS:A total of 406 patients (75%) had an admission blood glucose ≤120 mg/dL (mean ± SEM 98 ± 1 mg/dL), 103 children (19%) had an admission blood glucose level of 121–179 mg/dL (mean 143 ± 2 mg/dL), and 32 patients (5.9%) had a blood glucose level ≥180 mg/dL (mean 260 ± 18 mg/dL). Seventeen patients (13%) had a known history of diabetes prior to admission. Children with hyperglycemia were more likely to be admitted to the ICU (P < .001) and had a longer length of ICU stay (P < .001), but admission hyperglycemia was not associated with longer hospital stay or higher hospital mortality.CONCLUSIONS:Hyperglycemia is present in one‐fourth of children admitted to the hospital, most of them without a history of diabetes prior to admission. Hyperglycemia was associated with a greater need for ICU care and longer ICU stay but not with increased in‐hospital mortality. Journal of Hospital Medicine 2008;3:212–217. © 2008 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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“…Srinivasan et al 1 analisaram, em 2004, retrospectivamente, coorte de 179 crianças internadas em terapia intensiva, não-cirúrgicas, que estivessem em ventilação pulmonar mecânica e em uso de drogas vasoativas. Foi observada correlação direta entre picos glicêmicos e o desfecho principal avaliado que foi a mortalidade dos pacientes.…”

Section: Hiperglicemia E Pacientes Em Uti Pediátrica Geralunclassified

Hiperglicemia e morbimortalidade em crianças graves: análise crítica baseada em revisão sistemática

Filho¹,

Carvalho²,

Troster

2009

Rev. Assoc. Med. Bras.

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IntroDuçãoDiversas publicações dos últimos anos vêm demonstrando a importância das alterações endocrinológicas do paciente em terapia intensiva. As mesmas, além de muito frequentes, podem ser responsáveis por desfechos desfavoráveis às crianças doentes. não só pela frequência com a qual acomete os pacientes mas também pela hipótese cada vez mais considerada de haver relação estreita entre as mesmas e desfechos desfavoráveis aos doentes. A hiperglicemia está entre os mais importantes distúrbios e na população pediátrica, alvo desta revisão, estudos demonstram que tal alteração endocrinológica é altamente prevalente em crianças internadas em terapia intensiva.As taxas de incidência são variáveis e altas, tanto para picos isolados quanto para hiperglicemia persistente durante a internação, podendo atingir até 90% de acordo com os estudos analisados quando o corte para hiperglicemia estabelecido é de 110 mg/dL 1,2 . Situações críticas de estresse orgânico, como ocorre nos pacientes internados em terapia intensiva, estão correlacionadas com a ativação do eixo hipotálamo-hipofisário e, assim, diretamente ligada à secreção de cortisol pelas glândulas adrenais. Tal mecanismo é fundamental para a manutenção da homeostase e da resposta orgânica ao estresse, e vem acompanhado pela secreção conjunta dos chamados hormônios contra-reguladores da insulina -adrenalina e noradrenalina, cortisol e hormônio do crescimento. ConClusão.A partir da análise dos estudos listados concluímos que há evidências de que a hiperglicemia, tanto isolada como persistente durante internação em UTIP, aumenta a morbimortalidade em crianças gravemente doentes, bem como seu tempo de internação hospitalar; entretanto, tais estudos apresentam problemas metodológicos como ausência de protocolos específicos de coleta glicêmica, desenho (maioria coortes retrospectivos) e falta da caracterização isolada da hiperglicemia como preditor de morbimortalidade, sendo necessários, portanto, novos estudos prospectivos.

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“…In critically ill children, recent studies show that the intensity and duration of hyperglycemia are associated with outcome. 26 We have described the influence of glucose levels in children with septic shock, reporting a 2.6-fold rise in mortality when glucose levels exceed a peak level of 178 mg/dL. 27 In adults, Van den Berghe et al described the use of insulin to treat hyperglycemia and to normalize blood glucose levels.…”

Section: Glycemic Controlmentioning

confidence: 99%

Doença meningocócica e meningite

Branco

Amoretti

Tasker

2007

J. Pediatr. (Rio J.)

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Objective: To review the literature relevant to diagnosis and management of meningococcal disease (MD).Sources: Non-systematic review of medical literature through the MEDLINE database using the terms meningococcal, septic shock, diagnosis, and treatment. Articles were selected according to their relevance to the objective of the study and according to the authors' opinion. Summary of the findings:MD is a leading cause of death due to infection in children. It progresses rapidly and a high level of suspicion is necessary for early diagnosis. Early intervention with aggressive fluid resuscitation and

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Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children

Cited by 308 publications

References 43 publications

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Hiperglicemia e morbimortalidade em crianças graves: análise crítica baseada em revisão sistemática

Doença meningocócica e meningite

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