title: High Mortality Risk in Hypoglycemic and Dysglycemic Children Admitted at a Referral Hospital in a Non Malaria Tropical Setting of a Low Income Country.
abstract: BACKGROUND
  Hypoglycemia is a recognized feature of severe malaria but its diagnosis and management remain problematic in resource-limited settings. There is limited data on the burden and prognosis associated with glycemia dysregulation in non-neonate children in non-malaria areas. We prospectively assessed the abnormal blood glucose prevalence and the outcome and risk factors of deaths in critically ill children admitted to a national referral hospital in Laos.
  
  
  METHODS
  Consecutive children (1 month-15 years) admitted to the pediatric ward of Mahosot hospital, were categorized using the integrated management of childhood illness (IMCI). Blood glucose was assessed once on admission through a finger prick using a bedside glucometer. Glycemia levels: hypoglycemia: < 2.2 mmol/L (< 40 mg⁄ dl), low glycemia: 2.2-4.4 mmol/L (40-79 mg⁄ dl), euglycemia: 4.4-8.3 mmol/L (80-149 mg⁄ dl), and hyperglycemia: > 8.3 mmol/L (≥150 mg⁄ dl), were related to the IMCI algorithm and case fatality using univariate and multivariate analysis.
  
  
  RESULTS
  Of 350 children, 62.2% (n = 218) were severely ill and 49.1% (n = 172) had at least one IMCI danger sign. A total of 15 (4.2%, 95%CI: 2.4-6.9) had hypoglycemia, 99 (28.2%, 95%CI: 23.6-33.3) low glycemia, 201 (57.4%, 95% CI: 52.0-62.6) euglycemia and 35 (10.0%, 95% CI: 7.0-13.6) hyperglycemia. Hypoglycemia was associated with longer fasting (p = 0.001) and limited treatment before admission (p = 0.09). Hypoglycemia and hyperglycemia were associated with hypoxemia (SaO2) (p = 0.001). A total of 21 (6.0%) of the children died: 66.6% with hypoglycemic, 6.0% with low glycemic, 5.7% with hyperglycemic and 1.4% with euglycemic groups. A total of 9 (2.5%) deaths occurred during the first 24 hours of admission and 5 (1.7%) within 3 days of hospital discharge. Compared to euglycemic children, hypoglycemic and low glycemic children had a higher rate of early death (20%, p<0.001 and 5%, p = 0.008; respectively). They also had a higher risk of death (OR: 132; 95%CI: 29.0-596.5; p = 0.001; and OR: 4.2; 95%CI: 1.1-15.6; p = 0.02; respectively). In multivariate analyses, hypoglycemia (OR: 197; 95%CI: 33-1173.9), hypoxemia (OR: 5.3; 95%CI: 1.4-20), presence of hepatomegaly (OR: 8.7; 95%CI: 2.0-37.6) and having an illiterate mother (OR: 25.9; 95%CI: 4.2-160.6) were associated with increased risk of death.
  
  
  CONCLUSIONS
  Hypoglycemia is linked with a high risk of mortality for children in non malaria tropical settings. Blood sugar should be monitored and treatment provided for sick children, especially with danger signs and prolonged fasting. Further evaluations of intervention using thresholds including low glycemia is recommended in resource-limited settings. Research is also needed to determine the significance, prognosis and care of hyperglycemia.
authors.affiliation: Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR.|Agence Nationale de Recherche sur le VIH et les Hépatites, Phnom Penh, Cambodia.|Epidemiologie-Biostatistique, ISPED, Centre INSERM U897, Bordeaux University, F-Bordeaux, France.|Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia.
authors.forename: Hubert
authors.initials: H
authors.lastname: Barennes
authors.affiliation: Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR.
authors.forename: Eng
authors.initials: E
authors.lastname: Sayavong
authors.affiliation: Génétique Moléculaire, Pharmacogénétique et Hormonologie, Kremlin Bicêtre University Hospital, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Pussard
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000401:mortality* / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D007812:Laos; D008297:Male; D012307:Risk Factors; D015996:Survival Rate; D062606:Tertiary Care Centers