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Abstract

Introduction: Hyperglycemia is associated with poor outcomes in critically-ill adults with central line associated bloodstream infections (CLABSI). The impact of hyperglycemia on outcomes in critically-ill children with CLABSI is unknown. Hypothesis: Hyperglycemia is associated with intensive care unit (ICU) mortality in children with CLABSI. Methods: This is an IRB-approved retrospective review of pediatric (non-cardiac) ICU and pediatric cardiac ICU patients with CLABSI and? 1 measured blood glucose (BG) during the 4 days pre-CLABSI to 7 days post-CLABSI; we excluded patients with diabetes mellitus, metabolic disorders and those with a “do not attempt resuscitation” (DNAR) order. Demographic information, measures of illness severity including Pediatric Risk of Mortality (PRISM) III scores for pediatric ICU patients and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 scores for cardiac ICU patients, data on ventilator/vasopressor use, steroid use, and nutrition were collected. Primary outcome was ICU mortality. Analysis was by t-test and multivariable logistic regression. Results: 109 patients (57% cardiac ICU) were enrolled with a mortality of 24% and median ICU length of stay of 38 days (IQR: 20-91.5). The mean PRISM III score for PICU patients was 9 ± 9.35 at 12 hours and 12 ± 10.21 at 24 hours. Mean RACHS-1 score for cardiac ICU patients was 4 ± 1.68. Ninety-three percent of all patients required mechanical ventilation, 81% received total parenteral nutrition, 78% received steroids, and 78% required? 1 vasopressor during their ICU stay. Mean BG was significantly higher after CLABSI than before (149.3 ± 85 mg/dL vs. 138.5 ± 70 mg/dL, p<0.001). Non-survivors compared to survivors had higher mean BG (125 ± 56 mg/dL vs. 106 ± 32 mg/dL, p=0.03) and higher peak BG (250 ± 136 mg/dL vs. 189 ± 104 mg/dL, p=0.04). After controlling for confounders, peak BG was independently associated with ICU mortality (adjusted OR 1.01, 95% CI 1.01-1.03, p=0.02). Conclusions: Hyperglycemia is associated with ICU mortality in children with CLABSI. Control of blood glucose may improve outcomes in this population.Funded by Russell Raphaely Endowed Chair, CCM