Glucose dysregulation and neurological injury biomarkers in critically ill children.
BACKGROUND
Targeting normoglycemia with intensive insulin therapy (IIT) improved short-term outcome of pediatric intensive care unit (PICU) patients but increased the incidence of hypoglycemia. Both hyperglycemia and hypoglycemia may adversely affect the developing brain.


OBJECTIVE
We studied the impact of targeting normoglycemia with IIT on brain injury markers.


METHODS
This is a preplanned analysis of PICU patients included in a randomized controlled study.


METHODS
The study was conducted at a university hospital PICU.


METHODS
Seven hundred PICU patients participated.


METHODS
Patients were assigned to IIT targeting normal-for-age fasting blood glucose levels or insulin infusion only to prevent excessive hyperglycemia.


METHODS
Serum S100B and neuron-specific enolase (NSE), biomarkers of astrocytic and neuronal damage, respectively, were measured on fixed days (n = 700) and in a nested case-control design before and after hypoglycemia (n = 126).


RESULTS
Admission levels of S100B and NSE differed according to diagnosis and illness severity (P < 0.0001). IIT did not affect the time course of these markers. Patients experiencing hypoglycemia in PICU had higher S100B and NSE from admission onward than those without hypoglycemia. In the nested case-control study, both markers decreased after hypoglycemia (P = 0.001 and P = 0.009), unlike in the controls on matched days.


CONCLUSIONS
IIT in PICU did not evoke neurological damage detectable by circulating S100B and NSE, despite increased incidence of hypoglycemia. Elevated markers in patients with hypoglycemia were not caused by hypoglycemia itself but rather reflect an increased incidence of hypoglycemia in the most severely ill. This hypoglycemia risk appears difficult to capture by classical illness severity scores.
Vanhorebeek
Ilse
I
Department of Intensive Care Medicine, Katholieke Universiteit Leuven, Leuven, Belgium. ilse.vanhorebeek@med.kuleuven.be
Gielen
Marijke
M
Boussemaere
Magaly
M
Wouters
Pieter J
PJ
Grandas
Fabian Guiza
FG
Mesotten
Dieter
D
Van den Berghe
Greet
G
D015415:Biomarkers / Q000378:metabolism*; D001786:Blood Glucose / Q000032:analysis; D001930:Brain Injuries / Q000453:epidemiology / Q000378:metabolism*; D016022:Case-Control Studies; D002675:Child, Preschool; D016638:Critical Illness / Q000453:epidemiology; D005260:Female; D044882:Glucose Metabolism Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D012720:Severity of Illness Index
D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin