Blood glucose as a marker of venous thromboembolism in critically ill children

Abstract

SUMMARY Background The ability to predict the development of venous thromboembolism is highly desirable. Objective We aim to determine the association between hyperglycemia and venous thromboembolism in non-diabetic critically ill children. Patients/Methods We conducted a retrospective cohort study that included children in the pediatric intensive care unit on vasopressor or on mechanical ventilator and without history of diabetes mellitus or prior diagnosis of thrombosis. Based on maximum blood glucose >150 mg/dl while admitted to the unit, children were categorized as hyperglycemic or non-hyperglycemic. Primary outcome was development of venous thromboembolism while admitted to the unit. We determined the association between hyperglycemia and venous thromboembolism using logistic regression models adjusting for selected subject characteristics. Results Of the 789 subjects analyzed, 34 subjects developed venous thromboembolism (incidence: 4.3%; 95% confidence interval: 3.0%–6.0%). Venous thromboembolism was more likely to develop in hyperglycemic subjects compared with non-hyperglycemic subjects. A total of 31 subjects (6.2%; 95% confidence interval: 4.2%–8.7%) developed venous thromboembolism after becoming hyperglycemic compared with 3 non-hyperglycemic subjects with venous thromboembolism (1.0%, 95% confidence interval: 0.2%–3.0%). When adjusted for age, diagnosis, presence of central venous catheter, prophylactic antithrombotic use and severity of illness, the odds ratio of venous thromboembolism with hyperglycemia was 4.1 (95% confidence interval: 1.2–14.1). For every 10 mg/dl increase in maximum blood glucose, adjusted odds ratio of venous thromboembolism was 1.04 (95% confidence interval: 1.01–1.06). Conclusion Hyperglycemia is associated with venous thromboembolism in critically ill non-diabetic children. Maximum blood glucose is a potential predictor of venous thromboembolism in this population.

High-Dose Methylprednisolone Has No Benefit Over Moderate Dose for the Correction of Tetralogy of Fallot

“…Yates and colleagues [27] reported in a retrospective study that hyperglycemia is associated with increased organ dysfunction, infection, duration of ventilator treatment, PICU and hospital stay, and mortality rates in small children after cardiac operations. Moreover, in a retrospective cohort by Tala and associates [28], hyperglycemia was associated with increased venous thromboembolism in patients in the PICU. Because 30 mg/kg of MP produced hyperglycemia frequently but did not improve the clinical outcome, the use of higher MP doses cannot be recommended.…”

The timing of symptomatic pulmonary embolism in patients with non-warfarin following elective primary total joint arthroplasty

“…Additionally, symptomatic PE occurred earlier in patients with diabetes mellitus when compared to patients without diabetes mellitus. The association between diabetes mellitus and VTE has been confirmed in a lot of literatures [32][33][34]. It may be related to hyperglycemia, which can be related to the enhancement of blood coagulation function by damaging vascular endothelial cells [35,36].…”

Diabetic aggravation of stroke and animal models

“…Immediately after stable embolus or thrombus formation causes the occlusion of cerebral blood vessels, the supply of oxygen and glucose to some parts of the brain is reduced below a critical level which, if continued for a protracted period, results in a progressive loss of brain function seen during stroke (Roger et al, 2012). A heightened level of thromboembolism is noted in diabetic subjects having relatively less control over their hyperglycemia (Eyadiel et al, 2014; Lerstad et al, 2014; Tala et al, 2014). Naïve (non-diabetic) subjects suffering from acute ischemic attack are successfully treated with anticoagulant and/or anti-platelet drugs (Abdul-Rahim et al, 2015).…”