Glucose level and risk of mortality in pediatric septic shock*

Branco, Ricardo Garcia; García, Pedro Celiny Ramos; Piva, Jefferson Pedro; Casartelli, Carlos H.; Seibel, Vanessa; Tasker, Robert C.

doi:10.1097/01.pcc.0000161284.96739.3a

Cited by 165 publications

(101 citation statements)

References 12 publications

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“…An RCT of strict glycemic control compared to moderate control using insulin in a pediatric ICU population found a reduction in mortality with an increase in hypoglycemia. Insulin therapy should only be conducted with frequent glucose monitoring in view of the risks for hypoglycemia which can be greater in newborns and children due to a) relative lack of glycogen stores and muscle mass for gluconeogenesis, and b) the heterogeneity of the population with some excreting no endogenous insulin and others demonstrating high insulin levels and insulin resistance [622][623][624][625][626][627][628].…”

Section: Mechanical Ventilationmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

Dellinger¹,

et al. 2013

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Section: Mechanical Ventilationmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

Dellinger¹,

et al. 2013

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“…It is strongly associated with increased mortality [6][7][8][9][10]. Hyperglycemia is also associated with increases in other negative clinical outcomes, including infection [11], sepsis and septic shock [10,12,13], myocardial infarction [2], and polyneuropathy and multi-organ failure [3,14].…”

Section: The Physiological and Clinical Problemmentioning

confidence: 99%

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

119

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Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts.This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols.A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000 hours of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S I ). Variation in S I provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra-and inter-patient variability in insulin resistance (1/ S I ) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

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“…It is also noteworthy that apart from pneumonia which was found to be significantly associated with hypoglycaemia in bivariate analyses, some other known confounders of hypoglycaemia including malarial infestations, sepsis, undernutrition and diarrhoeal disease [18][19][20][21][22][23][24] were not seen to be associated with hypoglycaemia in this study. This finding is in contrast to that of Ile-Ife 39 where severa malaria, sepsis, pneumonia and malnutrition were found to be associated with hypoglycaemia and to that of Lagos 38 where severe malaria, sepsis, marasmus and diarrhoeal disease were found to be associated with hypoglycaemia.…”

Section: Discussionmentioning

confidence: 77%

“…Several studies [14][15][16][17] among HIV-infected Nigerian children have reported a high prevalence of malnutrition, diarrhoeal disease, pneumonia, septicaemia and malaria, all of which are known confounders of hypoglycaemia 18-22 and hyperglycaemia 18,23,24 outside the context of HIV infection. Regardless of the aetiopathogenesis of hypoglycaemia and hyperglycaemia in HIVinfection, both have been associated with increased morbidity and mortality in severely ill and nonseverely ill children, underlining the need for their evaluation, whenever they may be present 25,26 .…”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of dysglycaemia and its risk factors in a cohort of human immunodeficiency virus infected antiretroviral therapy naïve children in Makurdi, Nigeria

Anígilájé

2017

Sri Lanka J Child Health

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Background: Human immunodeficiency virus (HIV) endocrinopathy involving the pancreas manifests clinically as dysglycaemia, including hypoglycaemia and hyperglycaemia. Dysglycaemia increases mortality in sick children, underlying the need for its evaluation and management.Objective: To assess the prevalence and risk factors of dysglycaemia in a cohort of antiretroviral therapy (ART)-naïve children at the point of enrolment into a paediatric ART clinic of the Federal Medical Centre, Makurdi, Nigeria. Method:A retrospective cross-sectional study was carried out between June 2010 and June 2012. Hypoglycaemia was defined as random blood glucose level ˂2.2 mmol/l and hyperglycaemia as random blood glucose ˃6.6 mmol/l. Potential risk factors of dysglycaemia were tested for significance in bivariate and multivariate regression analyses. Pvalue less than 0.05 was considered to be significant.Results: 429 children, aged 1-15 years, including 223 males and 206 females were studied. The median age was 5 years. Twelve (2.8%) children had hypoglycaemia and 35 (8.2%) had hyperglycaemia. In multivariate regression analysis, no factor significantly predicted the risk of hypoglycaemia, whereas children co-infected with hepatitis C were at a significant risk of hyperglycaemia (adjusted odds ratio; 2.06, 95% CI; 1.05-8.52, P=0.03). Conclusions:In this study HIV-infected Nigerian children who were not on ART had a low prevalence of hypoglycaemia but a high prevalence of hyperglycaemia. Hepatitis C co-infection was a significant independent risk factor for hyperglycaemia. _________________________________________

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Glucose level and risk of mortality in pediatric septic shock*

Cited by 165 publications

References 12 publications

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

A retrospective analysis of dysglycaemia and its risk factors in a cohort of human immunodeficiency virus infected antiretroviral therapy naïve children in Makurdi, Nigeria

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