Impaired Pancreatic β-Cell Function in Critically Ill Children.

Shereen A Mohamed,Hossam M Abdelaziz,Hoiyda A Abdelrasol,Remon M Yousef,Nora E Badawi,Nirvana A Khalaf

doi:10.3389/fped.2021.603361

Shereen A Mohamed, Hossam M Abdelaziz + Show 4 more

Open Access

https://doi.org/10.3389/fped.2021.603361

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Abstract

Critical illness hyperglycemia (CIH) is common in the pediatric intensive care unit (PICU). Increased glucose production, insulin resistance (IR), and pancreatic β-cell dysfunction are responsible mechanisms. We aimed to investigate β-cell function in the PICU and to uncover its relation to clinical and laboratory variables and ICU mortality. We prospectively recruited 91 children. Pancreatic β-cell function was assessed by using a homeostasis model assessment (HOMA)-β. Patients with β-cell function <40.0% had significantly higher Pediatric Risk of Mortality III (PRISM III) scores, higher rates of a positive C-reactive protein (CRP), lower IR, and a longer hospital stay. The patients with 40–80% β-cell function had the highest IR. Intermediate IR was found when the β-cell function was >80%. ICU survivors had better β-cell function than ICU non-survivors. A multivariate logistic regression analysis revealed that higher PRISM III score and HOMA-β <80.0% were significant predictors of mortality. In conclusion, β-cell dysfunction is prevalent among PICU patients and influences patient morbidity and mortality.

Highlights

The management of glucose and insulin homeostasis in critically ill children is a complex issue
About 20 patients had a β-cell function>100% and insulin resistance (IR)>1, which were capable of maintaining normoglycemia in these patients
Group I patients (β-cell function

Summary

Introduction

The management of glucose and insulin homeostasis in critically ill children is a complex issue. Hyperglycemia and its related complications remain the most challenging endocrinological problem in the context of stress response [1]. Since the publication of the Leuven study in 2001, the role of tight glycemic control in the management of critically ill children and adults continues to be a matter of argument [2]. Recent evidence has undermined the value of tight glycemic control in pediatric intensive care unit (PICU). While it did not result in a reduced mortality, it was associated with an increased risk of hypoglycemia [3]. Hypoglycemia, in turn, is significantly associated with a worse short-term outcome [4]

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