title: Early change in blood glucose concentration is an indicator of mortality in critically ill children.
abstract: OBJECTIVE
  Hyperglycaemia is associated with increased mortality in critically ill patients. A number of studies have highlighted an association between increased variability of blood glucose (BG) concentration and mortality, supporting a survival disadvantage if BG homeostasis is lost. By exploring the longitudinal BG profile of individual children over time, this study investigates the importance of intact homeostasis early after admission to the paediatric intensive care unit (PICU).
  
  
  METHODS
  Retrospective single-centre observational study in a large multi-specialty PICU in the UK. Children admitted between August 2003 and February 2006 were included unless they met exclusion criteria. Data were merged from the PICU clinical database and blood gas analyser database by means of a unique PICU identifier. BG was measured frequently on a blood gas analyser (Bayer Rapidlink). Primary outcome was 100-day mortality. BG parameters were investigated for possible associations with mortality.
  
  
  RESULTS
  A total of 1,763 patients were included (median age 1.1 years; IQR 0.1-5.8). Although admission BG was not associated with mortality, a survival advantage was found in children who showed a reduction in BG on day 1 relative to the admission BG value (p < 0.001). This remained statistically significant (p = 0.007) after adjusting for severity of illness.
  
  
  CONCLUSIONS
  This study supports an association between early BG profile and mortality in children admitted to PICU, with increased survival in those who demonstrate a fall in BG on day 1 relative to PICU admission. These findings are consistent with a survival advantage of intact BG homeostasis.
authors.affiliation: Department of Paediatric Intensive Care Medicine, Birmingham Children's Hospital Foundation NHS Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
authors.forename: Prabhakar P
authors.initials: PP
authors.lastname: Nayak
authors.forename: Paul
authors.initials: P
authors.lastname: Davies
authors.forename: Parth
authors.initials: P
authors.lastname: Narendran
authors.forename: Simon
authors.initials: S
authors.lastname: Laker
authors.forename: Fang
authors.initials: F
authors.lastname: Gao
authors.forename: Stephen C L
authors.initials: SC
authors.lastname: Gough
authors.forename: John
authors.initials: J
authors.lastname: Stickley
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Morris
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality*; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality; D007223:Infant; D008137:Longitudinal Studies; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose