title: Pathophysiological aspects of hyperglycemia in children with meningococcal sepsis and septic shock: a prospective, observational cohort study.
abstract: BACKGROUND
  The objective of this study was to investigate the occurrence of hyperglycemia and insulin response in critically ill children with meningococcal disease in the intensive care unit of an academic children's hospital.
  
  
  METHODS
  Seventy-eight children with meningococcal disease were included. The group was classified into shock non-survivors, shock survivors and sepsis survivors. There were no sepsis-only non-survivors. The course of laboratory parameters during 48 hours was assessed. Insulin sensitivity and β-cell function on admission were investigated by relating blood glucose level to insulin level and C-peptide level and by homeostasis model assessment (HOMA) [β-cell function (HOMA-%B) and insulin sensitivity (HOMA-%S)].
  
  
  RESULTS
  On admission, hyperglycemia (glucose >8.3 mmol/l) was present in 33% of the children. Shock and sepsis survivors had higher blood glucose levels compared with shock non-survivors. Blood glucose level on admission correlated positively with plasma insulin, C-peptide, cortisol, age and glucose intake. Multiple regression analysis revealed that both age and plasma insulin on admission were significantly related to blood glucose. On admission, 62% of the hyperglycemic children had overt insulin resistance (glucose >8.3 mmol/l and HOMA-%S <50%); 17% had β-cell dysfunction (glucose >8.3 mmol/l and HOMA-%B <50%) and 21% had both insulin resistance and β-cell dysfunction. Hyperglycemia was present in 11% and 8% of the children at 24 and 48 hours after admission, respectively.
  
  
  CONCLUSIONS
  Children with meningococcal disease often show hyperglycemia on admission. Both insulin resistance and β-cell dysfunction play a role in the occurrence of hyperglycemia. Normalization of blood glucose levels occurs within 48 hours, typically with normal glucose intake and without insulin treatment.
authors.affiliation: Department of Intensive Care, Erasmus MC - Sophia Children's Hospital, Dr, Molewaterplein 60, Rotterdam 3015 GJ, The Netherlands. j.j.verhoeven@erasmusmc.nl
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Verhoeven
authors.forename: Marieke
authors.initials: M
authors.lastname: den Brinker
authors.forename: Anita C S
authors.initials: AC
authors.lastname: Hokken-Koelega
authors.forename: Jan A
authors.initials: JA
authors.lastname: Hazelzet
authors.forename: Koen F M
authors.initials: KF
authors.lastname: Joosten
mesh_terms: D001402:B-Lymphocytes / Q000502:physiology; D016470:Bacteremia / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology*; D007223:Infant; D007333:Insulin Resistance / Q000502:physiology; D015278:Intensive Care Units, Pediatric; D008297:Male; D008589:Meningococcal Infections / Q000097:blood*; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood*