Abstract
Stress hyperglycemia and hyperlactatemia are commonly referred to as markers of stress severity and poor outcome in children with severe acute illness or febrile seizures. Our prospective study aimed to explore the risk factors for stress hyperglycemia and the predictive value of stress hyperglycemia for febrile seizure recurrence. We evaluated as risk factors for blood glucose level, serum lactate, acid–base status, and the clinical parameters relevant to the severity of the infectious context or to febrile seizure event: fever degree, fever duration, seizure type and aspect, seizure duration, and recurrence. Among 166 febrile seizures events in 128 children, the prevalence of stress hyperglycemia (blood glucose >140 mg/dl) was 16.9%. The comparison of the stress versus non-stress hyperglycemia groups revealed lower pH (median (interquartile range): 7.46 (7.37, 7.53) vs. 7.48 (7.42, 7.53), p = 0.049), higher lactate levels (30.50 mg/dl (15, 36) vs. 19.50 mg/dl (15, 27), p = 0.000), slightly lower HCO3 (20.15 (20.20, 21.45) vs. 21.35 (20, 22.40), p = 0.020) in the stress hyperglycemia group. Multiple logistic regression analysis showed that prolonged febrile seizures (>15 min), recurrent febrile seizure (>1 seizure), focal seizure type, body temperature ≥39.5 °C and higher lactate values were significantly associated with stress hyperglycemia. These findings suggest a particular acute stress reaction in febrile seizures, with stress hyperglycemia playing an important role, particularly in patients with a recurrent seizure pattern. A more complex future approach linking pathogenic mechanisms and genetic traits would be advised and could provide further clues regarding recurrence pattern and individualized treatment.
Highlights
Febrile seizures are reported among stress-related conditions correlated with stress hyperglycemia.Stress hyperglycemia is defined as transient high blood glucose levels, with spontaneous resolution after the acute illness regresses [1]
We evaluated the possible association of blood glucose levels with serum lactate, acid–base status, clinical parameters that define the severity of both infectious context, and febrile seizures
The time interval up to six hours between fever onset and seizure event was observed in a higher proportion in the stress hyperglycemia group, invalidating the value of prolonged infectious context as a risk factor for stress hyperglycemia. These findings suggest seizure activity as main risk factor for stress hyperglycemia, the exact contribution of seizure activity or febrile/infectious context to the development of stress hyperglycemia associated with febrile seizure remains uncertain
Summary
Febrile seizures are reported among stress-related conditions correlated with stress hyperglycemia.Stress hyperglycemia is defined as transient high blood glucose levels, with spontaneous resolution after the acute illness regresses [1]. The proposed triggering mechanisms in febrile seizures are temperature-sensitive ion channels and increased neuronal excitability in the context of proinflammatory cytokines [3]. Both seizure activity and fever-illness context have common stress-related mechanisms with high metabolic states, Brain Sci. 2020, 10, 131; doi:10.3390/brainsci10030131 www.mdpi.com/journal/brainsci. More than a byproduct of anaerobiosis, the lactate emerges as an important gluconeogenetic precursor, energy source, and as a key player for adapting to stress-related conditions [19,20]) It seems that high levels of lactate might have a dual protective role during the initial stage and at the end of the seizure event in the context of metabolic acidosis [21]
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