Etiology of hyperglycemia in critically ill children and the impact of organ dysfunction

• Published in: Revista Brasileira de terapia intensiva Vol. 30; no. 3; pp. 286 - 293
• Main Authors: El-Sherbini, Seham Awad, Marzouk, Huda, El-Sayed, Riham, Hosam-ElDin, Sarah
• Format: Journal Article
• Language: Portuguese; English
• Published: Brazil Associação de Medicina Intensiva Brasileira - AMIB 01.07.2018
• Subjects: Blood Glucose - metabolism; C-Peptide - blood; Case-Control Studies; Child; Child, Preschool; Cohort Studies; Critical Illness; Egypt; Female; Homeostasis; Humans; Hyperglycemia - epidemiology; Hyperglycemia - etiology; Incidence; Infant; Insulin - blood; Insulin-Secreting Cells - pathology; Intensive Care Units, Pediatric; Male; Multiple Organ Failure - epidemiology; Multiple Organ Failure - physiopathology; Original; Prospective Studies; Sepsis - complications; Sepsis - epidemiology; Stress, Physiological - physiology; Egypt
• ISSN: 0103-507X; 1982-4335
• DOI: 10.5935/0103-507X.20180051

This study aimed to study the incidence of stress hyperglycemia in critically ill children and to investigate the etiological basis of the hyperglycemia based on homeostasis model assessment. This was a prospective cohort study in one of the pediatric intensive care units of Cairo University, including 60 critically ill children and 21 healthy controls. Serum blood glucose, insulin, and C-peptide levels were measured within 24 hours of admission. Homeostasis model assessment was used to assess β-cell function and insulin sensitivity. Hyperglycemia was estimated in 70% of patients. Blood glucose values ≥ 180mg/dL were associated with a poor outcome. Blood glucose levels were positively correlated with Pediatric Risk for Mortality (PRISM III) score and number of organ dysfunctions (p = 0.019 and p = 0.022, respectively), while insulin levels were negatively correlated with number of organ dysfunctions (r = -0.33, p = 0.01). Homeostasis model assessment revealed that 26 (43.3%) of the critically ill patients had low β-cell function, and 18 (30%) had low insulin sensitivity. Combined pathology was detected in 2 (3.3%) patients only. Low β-cell function was significantly associated with the presence of multi-organ dysfunction; respiratory, cardiovascular, and hematological dysfunctions; and the presence of sepsis. β-Cell dysfunction appeared to be prevalent in our cohort and was associated with multi-organ dysfunction.