[Hyperglycemia and mortality in critically ill children].
Several pathologic conditions are accompanied by stress-induced hyperglycemia in non-diabetic individuals which influences mortality and morbidity.


OBJECTIVE
Prospective studies in adults support that glycemic control is an independent predictor of survival and normoglycemia has a beneficial effect on the outcome of patients. Few data are available in children, however a retrospective study documented significant correlation between mortality and duration, intensity and peak value of hyperglycemia. In the present study, the authors investigated the relationship between blood glucose level and pathological process in a multidisciplinary pediatric intensive care department retrospectively.


RESULTS
It has been shown that highest blood glucose values were associated with fatal outcome independent of diagnosis (mean: 14,38 mmol/l) and with septicemia independent of final outcome (mean: 13,97 mmol/l). Patients with fatal outcome were hyperglycemic during the total duration (mean: 7,59 mmol/l) and on the last day (mean: 7,00 mmol/l) of treatment. Patients who survived had significantly lower blood glucose over the whole duration (mean: 6,52 mmol/l; p < 0,01) and on the last day of treatment (mean: 5,28 mmol/l; p < 0,01) than those who died. Percent of treatment days with blood glucose > = 6,1 mmol/l was significantly lower in case of survival as compared with fatal cases (42,68 vs. 74.07 %; p < 0,01) and the highest rate was observed in those with fatal septcemia (mean: 76,52 %).


CONCLUSIONS
These data support that, similarly to adults, critical condition in children induces sustained hyperglycemia and higher peak values and longer duration of elevated blood glucose are associated with higher mortality rate. Septicemia proved to be potent inductor of abnormalities of carbohydrate metabolism.
Mikos
Borbála
B
Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház, Gyermekegészségügyi Továbbképzo Intézet, IV. Gyermekosztály, Gyermek-Aneszteziológiai és Intenzív Osztály, Miskolc. mikos.gyekint@bazmkorhaz.hu
Barkai
László
L
D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D006814:Hungary; D006943:Hyperglycemia / Q000097:blood* / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality*; D007004:Hypoglycemic Agents / Q000378:metabolism / Q000627:therapeutic use*; D007223:Infant; D007328:Insulin / Q000378:metabolism / Q000627:therapeutic use*; D015278:Intensive Care Units, Pediatric; D033183:Interdisciplinary Communication; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000401:mortality
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin