Effect of hyperglycemia on all-cause mortality from pediatric brain injury

Chen, Shuyun; Liu, Zhaohe

doi:10.1097/md.0000000000023307

Cited by 5 publications

(5 citation statements)

References 38 publications

(18 reference statements)

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“…Hyperglycemia is not a physiological or benign condition; clinically, hyperglycemia has been linked to increased incidences of sepsis, longer hospital stays and higher mortality [ 39 , 40 , 41 ]. A continuous glucose monitoring may be useful to detect glycemic fluctuation and to prevent metabolic imbalance.…”

Section: Discussionmentioning

confidence: 99%

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

et al. 2021

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An interaction between metabolic glucose impairment and coronavirus disease 2019 is reported. The development of a severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 infection has been described. We evaluated the impact of MIS-C on glycemic patterns in pediatric patients. A group of 30 children and adolescents affected by MIS-C were considered; all patients were normal weight. Clinical and biochemical assessments, including surrogate markers of insulin resistance (IR) such as homeostasis model analysis-IR (HOMA-IR) and triglyceride–glucose (TyG) indexes, were recorded. Patients were also invited to undergo an intermittently scanned continuous glucose monitoring (isCGM). HOMA-IR index was calculated in 18 patients (60%), of which 17 (94%) revealed a pathological value. TyG index was computed for all patients and pathological values were detected in all cases. In 15 patients, isCGM data were recorded on average for 9 days (±3 days). Overall, average glucose was 105 mg/dL (±16 mg/dL) and average time spent in the 70–180 mg/dL range (TIR) was 93.76%, with nearly 10% of glucose readings in the 141–180 mg/dL range; glycemic fluctuations over the hyperglycemic threshold were detected in four patients. Regular glucose monitoring may be useful to prevent metabolic imbalance and obtain a better outcome.

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Section: Discussionmentioning

confidence: 99%

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

et al. 2021

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“…Numerous studies have investigated serum glucose as a prognostic marker in TBI (5,10,11,14,15). We followed prior thresholds for hyperglycemia, conventionally defined as glucose ≥11.1 mmol/L (5,12,23).…”

Section: Discussionmentioning

confidence: 99%

“…The association between these metabolic alterations and outcomes of pediatric TBI have been investigated in several single-center studies (2,5,8,9). These prior single-center studies have identified admission hyperglycemia as an important predictor of mortality in pediatric TBI (9)(10)(11)(12)(13)(14). Early hyperglycemia has been traditionally described as the presence of any hyperglycemia in the first 48 h of injury (13,14), while other retrospective cohort studies have proposed a shorter window between 12 to 24 h post injury (5,15).…”

Section: Introductionmentioning

confidence: 99%

“…Early hyperglycemia has been traditionally described as the presence of any hyperglycemia in the first 48 h of injury (13,14), while other retrospective cohort studies have proposed a shorter window between 12 to 24 h post injury (5,15). The association between early, compared to late or persistent hyperglycemia and pediatric TBI outcomes has not been well-established (9)(10)(11)(12)(13)(14). Additionally, mortality has been the primary outcome of interest in these studies whereas functional outcome has been less adequately described (9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

“…The association between early, compared to late or persistent hyperglycemia and pediatric TBI outcomes has not been well-established (9)(10)(11)(12)(13)(14). Additionally, mortality has been the primary outcome of interest in these studies whereas functional outcome has been less adequately described (9)(10)(11)(12)(13)(14). Furthermore, while lactate and acidosis in adult multisystem trauma are associated with massive hemorrhage and prolonged ICU admission (16,17), there is a paucity of literature examining their roles as prognostic markers in pediatric TBI (2,4).…”

Section: Introductionmentioning

confidence: 99%

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Early metabolic derangements and unfavorable outcomes in pediatric traumatic brain injury: a retrospective multi-center cohort study

Yao¹,

Chong²,

Allen³

et al. 2023

Transl Pediatr

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Background: To study the association in moderate and severe pediatric traumatic brain injury (TBI) between hyperglycemia, hyperlactatemia, acidosis and unfavorable outcome, as assessed by Pediatric Cerebral Performance Category (PCPC) on discharge from the pediatric intensive care unit (PICU).Methods: Children <16 years old with TBI and Glasgow Coma Scale (GCS) ≤13 in an Asian multi-center PICU TBI cohort from January 2014 to October 2017 were included in this study. We defined unfavorable outcome as PCPC ≥3-moderate disability, severe disability, vegetative state, and death. We performed logistic regression to investigate the association between metabolic changes with unfavorable outcome. We divided hyperglycemia (glucose >11.1 mmol/L) during PICU admission into early-onset (within 24 h), lateonset (beyond 48 h) and persistent (throughout first 72 h).Results: Among the 305 children analyzed, 136 (44.6%) had unfavorable outcome. Children with unfavorable outcome were more likely to have early hyperglycemia (75/136, 55.1% vs. 33/169, 19.5%; P<0.001), high lactate levels >2.0 mmol/L (74/136, 54.4% vs. 56/169, 32.5%; P<0.001) and initial acidosis (85/136, 62.5% vs. 78/169, 56.1%; P=0.003) compared to those with favorable outcome. After adjusting for gender, GCS ≤8 and presence of polytrauma, early hyperglycemia [adjusted odds ratio (aOR) =3.68, 95% CI: 2.12-6.39, P<0.001] and late hyperglycemia (aOR =13.30, 95% CI: 1.64-107.8, P=0.015] were independently associated with unfavorable outcome. All children with persistent hyperglycemia died. Conclusions:We described unfavorable outcome in pediatric TBI especially with persistent hyperglycemia.Future trials should investigate the causal relationship between glycemic trends, early intervention and outcome in this cohort.

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Predicting factors for acute encephalopathy in febrile seizure children with SARS-CoV-2 omicron variant: a retrospective study

Tang,

Kuo,

Yen

et al. 2024

BMC Pediatr

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Background SARS-CoV-2 posed a threat to children during the early phase of Omicron wave because many patients presented with febrile seizures. The study aimed to investigate predicting factors for acute encephalopathy of children infected by SARS-CoV-2 Omicron variant presenting with febrile seizures. Methods The retrospective study analyzed data from pediatric patients who visited the emergency department of Chang Gung Memorial Hospital in Taiwan between April and July 2022. We specifically focused on children with COVID-19 who presented with febrile seizures, collecting demographic, clinical, and laboratory data at the pediatric emergency department, as well as final discharge diagnoses. Subsequently, we conducted a comparative analysis of the clinical and laboratory characteristics between patients diagnosed with acute encephalopathy and those with other causes of febrile seizures. Results Overall, 10,878 children were included, of which 260 patients presented with febrile seizures. Among them, 116 individuals tested positive for SARS-CoV-2 and of them, 14 subsequently developed acute encephalopathy (12%). Those with acute encephalopathy displayed distinctive features, including older age (5.1 vs. 2.6 years old), longer fever duration preceding the first seizure (1.6 vs. 0.9 days), cluster seizure (50% vs. 16.7%), status epilepticus (50% vs. 13.7%) and occurrences of bradycardia (26.8% vs. 0%) and hypotension (14.3% vs. 0%) in the encephalopathy group. Besides, the laboratory findings in the encephalopathy group are characterized by hyperglycemia (mean (95% CI) 146 mg/dL (95% CI 109–157) vs. 108 mg/dL (95% CI 103–114) and metabolic acidosis (mean (95% CI) pH 7.29(95% CI 7.22–7.36) vs. 7.39 (95%CI 7.37–7.41)). Conclusions In pediatric patients with COVID-19-related febrile seizures, the occurrence of seizures beyond the first day of fever, bradycardia, clustered seizures, status epilepticus, hyperglycemia, and metabolic acidosis should raise concerns about acute encephalitis/encephalopathy. However, the highest body temperature and the severity of leukocytosis or C-reactive protein levels were not associated with poor outcomes.

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Effect of hyperglycemia on all-cause mortality from pediatric brain injury

Cited by 5 publications

References 38 publications

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

Impaired Glucose-Insulin Metabolism in Multisystem Inflammatory Syndrome Related to SARS-CoV-2 in Children

Early metabolic derangements and unfavorable outcomes in pediatric traumatic brain injury: a retrospective multi-center cohort study

Predicting factors for acute encephalopathy in febrile seizure children with SARS-CoV-2 omicron variant: a retrospective study

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