Blood glucose and outcomes in critically ill children in Brazilian Amazon: an observational study

Abstract

Objectives: To determine blood glucose distribution values; to assess the association of admission serum glucose levels with 28-day mortality to the frequency of invasive mechanical ventilation-free days. Design: Retrospective cohort studySetting: Brazilian Amazon Region. Patients: Population (n = 400) composed of patients admitted to the pediatric intensive care unit, from January 2016 to December 2017. Exclusion criteria were patients with length of stay of <24 hours; diabetes mellitus; suspicion or evidence of inborn errors of metabolism; insulin use; palliative care and brain death. Main outcome measures: The patients were divided into 4 groups: 1) serum glucose <60mg/dL; 2) control group if serum glucose between 60-126 mg/dL; 3) between 127-150mg/dL; or 4) if > 150mg/dL. Results: Serum glucose levels frequency were: <60: 43 (11%); 60-126: 235 (58.7%); 127-150: 51 (13%) and > 150: 71 (18%). Groups 3 and 4 had the highest frequency of external origin, with respectively 24 (47.1%) and 40 (56.3%); the main diagnosis was infection, with 26 (51%) and 50 (70.4%), respectively. Sepsis occurred in 24 (47.1%) and 47 (66.2%) individuals in the groups 3 and 4, respectively, while septic shock was more frequent in the group 4 (46 [4.8%]). Group 2 had predominance of ventilator-associated pneumonia with 11 (36.7%). The estimate of ventilation-free days in group 4 was 2.84 (SD +/- 0.69; 95% CI: 1.5-4.2). Conclusion: Hyperglycemia group had a lower frequency of ventilation-free days and higher 28-day mortality.