Abstract
BackgroundTo study hormonal changes associated with severe hyperglycemia in critically ill children and the relationship with prognosis and length of stay in intensive care.MethodsObservational study in twenty-nine critically ill children with severe hyperglycemia defined as 2 blood glucose measurements greater than 180 mg/dL. Severity of illness was assessed using pediatric index of mortality (PIM2), pediatric risk of mortality (PRISM) score, and pediatric logistic organ dysfunction (PELOD) scales. Blood glucose, glycosuria, insulin, C-peptide, cortisol, corticotropin, insulinlike growth factor-1, growth hormone, thyrotropin, thyroxine, and treatment with insulin were recorded. β-cell function and insulin sensitivity and resistance were determined on the basis of the homeostatic model assessment (HOMA), using blood glucose and C-peptide levels.ResultsThe initial blood glucose level was 249 mg/dL and fell gradually to 125 mg/dL at 72 hours. Initial β-cell function (49.2%) and insulin sensitivity (13.2%) were low. At the time of diagnosis of hyperglycemia, 50% of the patients presented insulin resistance and β-cell dysfunction, 46% presented isolated insulin resistance, and 4% isolated β-cell dysfunction. β-cell function improved rapidly but insulin resistance persisted. Initial glycemia did not correlate with any other factor, and there was no relationship between glycemia and mortality. Patients who died had higher cortisol and growth hormone levels at diagnosis. Length of stay was correlated by univariate analysis, but not by multivariate analysis, with C-peptide and glycemic control at 24 hours, insulin resistance, and severity of illness scores.ConclusionsCritically ill children with severe hyperglycemia initially present decreased β-cell function and insulin sensitivity. Nonsurvivors had higher cortisol and growth hormone levels and developed hyperglycemia later than survivors.
Highlights
To study hormonal changes associated with severe hyperglycemia in critically ill children and the relationship with prognosis and length of stay in intensive care
A prospective observational study was performed in patients aged between 1 month and 16 years admitted to the Pediatric Intensive Care Unit (PICU) between July 2009 and March 2010 and who developed significant hyperglycemia, defined as 2 blood glucose measurements greater than 180 mg/dL, separated by at least 2 hours, at any time during admission to the PICU
The doses of vasoactive drugs, the vasoactive score calculated by the following formula: dopamine dose + dobutamine dose + 100 epinephrine dose + 10 milrinone dose + 10.000 vasopresine dose (U/kg/min) + 100 noerpinephrine dose [15], blood glucose, glycosuria, insulin, C-peptide, cortisol, corticotropin (ACTH), insulinlike growth factor (IGF-1), growth hormone (GH), thyrotropin (TSH), free thyroxine (T4), and dose of insulin treatment were recorded at the time of diagnosis of hyperglycemia and 24 and 72 hours later
Summary
To study hormonal changes associated with severe hyperglycemia in critically ill children and the relationship with prognosis and length of stay in intensive care. The incidence of hyperglycemia is very high, between 56 and 86%, and it is an independent risk factor for morbidity and mortality in critically ill patients [1,2,3]. Many studies have analyzed the effect of treatment of hyperglycemia on the prognosis of critically ill patients. Few studies have investigated the pathophysiological mechanisms involved in hyperglycemia of the critically ill patient [8,9,10,11]. Hyperglycemia of critically ill adults and children have different characteristics. An understanding of the mechanisms that give rise to hyperglycemia in the critically ill child could help to define the most appropriate treatment
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