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.

Prognostic Value of Serum Glucose Level in Critically Ill Septic Patients on Admission to Pediatric Intensive Care Unit

“…Also, non-survivors had a higher percentage of inotropic support (87.8%) with a statistical significance, which is in accordance with the following studies: Tirkey and Verma 33 and de Farias et al 17 However, we found no statistical difference between living and deceased patients regarding gender or the presence of any system affection.…”

“…This study demonstrated that non-survivors had shorter PICU stay, with a median of 2 (IQR 1–6) days, which may be the cause of their shorter stay and subsequent mortality. On the other hand, another study by de Farias et al 17 revealed that PICU stay did not significantly affect the outcome, with a p -value of 0.08.…”

“…Glucose homeostasis varies among children with septic shock. 17 Therefore, we aimed to detect the relation between critically ill septic patients and their initial RBG.…”