Glycemia upon admission and mortality in a pediatric intensive care unit

Abstract

Objectives To analyze the association between glycemia levels upon pediatric intensive care unit admission and mortality in patients hospitalized.MethodsA retrospective cohort of pediatric intensive care unit patients admitted to the Instituto Nacional de Salud del Niño between 2012 and 2013. A Poisson regression model with robust variance was used to quantify the association. Diagnostic test performance evaluation was used to describe the sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios for each range of glycemia.ResultsIn total, 552 patients were included (median age 23 months, age range 5 months to 79.8 months). The mean glycemia level upon admission was 121.3mg/dL (6.73mmol/L). Ninety-two (16.6%) patients died during hospitalization. In multivariable analyses, significant associations were found between glycemia < 65mg/dL (3.61mmol/L) (RR: 2.01, 95%CI 1.14 - 3.53), glycemia > 200mg/dL (> 11.1mmol/L) (RR: 2.91, 95%CI 1.71 - 4.55), malnutrition (RR: 1.53, 95%CI 1.04 - 2.25), mechanical ventilation (RR: 3.71, 95%CI 1.17 - 11.76) and mortality at discharge. There was low sensitivity (between 17.39% and 39.13%) and high specificity (between 49.13% and 91.74%) for different glucose cut-off levels.Conclusion There was an increased risk of death at discharge in patients who developed hypoglycemia and hyperglycemia upon admission to the pediatric intensive care unit. Certain glucose ranges (> 200mg/dL (> 11.1mmol/L) and < 65mg/dL (3.61mmol/L)) have high specificity as predictors of death at discharge.

Biomarker-based score for predicting in-hospital mortality of children admitted to the intensive care unit

“…The pediatric intensive care unit (PICU) is responsible for providing comprehensive monitoring and life support for critically ill children. According to reports, the observed mortality rate in the PICU is 5.3%–37.35% in developing countries,1 2 which is higher than in developed countries 3. It brings a heavy economic burden on the family and society 4.…”

“…According to reports, the observed mortality rate in the PICU is 5.3%-37.35% in developing countries, 1 2 which is higher than in developed countries. 3 It brings a heavy economic burden on the family and society. 4 Therefore, in order to optimise the diagnostic approach, care and outcome for critically ill children, the early identification of the development of poor prognosis is considered imperative.…”

Dysglycemia in Critically Ill Children Admitted to Jimma Medical Centre, Southwest Ethiopia

“…Various studies have shown the association of glucose variability with increased mortality. A study done in India showed that patients with isolated blood glucose variability were 5.4 times more likely to die than those with no blood glucose abnormality (8,11) (11).…”

“…Various studies have shown the association of glucose variability with increased mortality. A study done in India showed that patients with isolated blood glucose variability were 5.4 times more likely to die than those with no blood glucose abnormality ( 8 , 11 ). Besides increased mortality, dysglycemic patients are more likely to develop complications which include worsening organ function, multiorgan dysfunction syndrome and long term consequences like neurologic damage resulting in mental retardation, developmental delay, recurrent seizures and personality disorders associated with hypoglycemia ( 5 , 10 – 12 ).…”

“…Besides increased mortality, dysglycemic patients are more likely to develop complications which include worsening organ function, multiorgan dysfunction syndrome and long term consequences like neurologic damage resulting in mental retardation, developmental delay, recurrent seizures and personality disorders associated with hypoglycemia ( 5 , 10 – 12 ). Additionally, both hyperglycemia and glucose variability are associated with long pediatric ICU (PICU) stay ( 11 ).…”