title: Malnutrition may worsen the prognosis of critically ill children with hyperglycemia and hypoglycemia.
abstract: OBJECTIVE
  To determine whether hyperglycemia and hypoglycemia are associated with higher mortality, longer length of intensive care unit (ICU) stay, and fewer ventilator-free days in critically ill children while taking into account the clinical severity and nutrition status.
  
  
  METHODS
  A prospective observational cohort study was conducted on 221 children admitted to the ICU. Blood glucose levels were analyzed in the first 72 hours. Potential exposure variables for adverse prognosis included hyperglycemia (blood glucose >150 mg/dL), hypoglycemia (blood glucose ≤60 mg/dL), age <1 year, sex, nutrition status, the revised Pediatric Index of Mortality (PIM 2), and the Pediatric Logistic Organ Dysfunction (PELOD).
  
  
  RESULTS
  Of the patients, 47.1% were malnourished. Controlling for nutrition status, both hyperglycemia and hypoglycemia increased the risk of mortality in the malnourished patients compared with the well-nourished ones. Adjusting for clinical severity, the odds ratio of mortality was higher in malnourished patients with hyperglycemia (odds ratio [OR], 3.98; 95% confidence interval [CI], 1.14-13.94; P = .03), whereas no significant associations were detected in the well-nourished patients. After controlling for nutrition status, hypoglycemia was associated with longer length of ICU stay (OR, 6.5; 95% CI, 1.30-32.57; P < .01) and fewer ventilator-free days (OR, 4.11; 95% CI, 1.26-13.40; P < .01) only in the malnourished group of patients.
  
  
  CONCLUSIONS
  Compared with the well nourished, malnourished patients with hyperglycemia are at a greater risk of mortality, independent of clinical severity. Hypoglycemia was shown to be associated with mortality, longer length of ICU stay, and fewer ventilator-free days only in malnourished patients.
authors.affiliation: Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil. heitorpons@gmail.com
authors.forename: Heitor Pons
authors.initials: HP
authors.lastname: Leite
authors.forename: Lúcio Flávio Peixoto
authors.initials: LF
authors.lastname: de Lima
authors.forename: Simone Brasil
authors.initials: SB
authors.lastname: de Oliveira Iglesias
authors.forename: Juliana Cristina
authors.initials: JC
authors.lastname: Pacheco
authors.forename: Werther Brunow
authors.initials: WB
authors.lastname: de Carvalho
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D007003:Hypoglycemia / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose