Organ dysfunction is associated with hyperglycemia in critically ill children.
OBJECTIVE
To determine the association between organ dysfunction and hyperglycemia in critically ill children receiving intravenous insulin.


METHODS
Retrospective chart review (cohort study).


METHODS
Pediatric intensive care unit in a university hospital.


METHODS
n = 110 patients; inclusion criteria: ICU hospitalization from May 2005 to May 2006; insulin drip to manage hyperglycemia.


METHODS
insulin drip <48 h; diabetic patients.


METHODS
Duration of hyperglycemia: sum of hours of hyperglycemia (> or =126 mg/dl). Hypoglycemia (blood glucose <40 mg/dl). Organ dysfunction was determined per International Pediatric Sepsis Consensus Conference criteria. Multiple logistic regression models determined the association between > or =3 compared to <3 organ dysfunctions and hyperglycemia, hypoglycemia, and mortality, after adjustment for confounding variables (age, gender, PRISM score, vasopressors, steroids).


RESULTS
Organ dysfunction > or =3 compared to <3 after adjustment for confounders was associated with intermittent hyperglycemia of > or =24 h (OR 6.1, CI 1.8-21.2; p = 0.004). Hyperglycemia trended towards significance with mortality [3.2 (CI 0.9-11.6, p = 0.079)]. Hypoglycemia, after adjusting for the above, was not associated with mortality.


CONCLUSIONS
Organ dysfunction (> or =3 versus <3) was significantly associated with hyperglycemia for > or =24 h and hypoglycemia. Hyperglycemia trended toward significance with mortality in critically ill children. There was no association between hypoglycemia and mortality.
Kyle
Ursula G
UG
Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, WT6-006, Houston, Texas 77030, USA. ukyle@bcm.tmc.edu
Coss Bu
Jorge A
JA
Kennedy
Curtis E
CE
Jefferson
Larry S
LS
D001786:Blood Glucose; D002648:Child; D016638:Critical Illness; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index
D001786:Blood Glucose