Organ dysfunction is associated with hyperglycemia in critically ill children.

OBJECTIVE

To determine the association between organ dysfunction and hyperglycemia in critically ill children receiving intravenous insulin.

DESIGN

Retrospective chart review (cohort study).

SETTING

Pediatric intensive care unit in a university hospital.

PATIENTS

n = 110 patients; inclusion criteria: ICU hospitalization from May 2005 to May 2006; insulin drip to manage hyperglycemia.

EXCLUSION CRITERIA

insulin drip <48 h; diabetic patients.

MEASUREMENTS

Duration of hyperglycemia: sum of hours of hyperglycemia (> or =126 mg/dl). Hypoglycemia (blood glucose <40 mg/dl). Organ dysfunction was determined per International Pediatric Sepsis Consensus Conference criteria. Multiple logistic regression models determined the association between > or =3 compared to <3 organ dysfunctions and hyperglycemia, hypoglycemia, and mortality, after adjustment for confounding variables (age, gender, PRISM score, vasopressors, steroids).

MAIN RESULTS

Organ dysfunction > or =3 compared to <3 after adjustment for confounders was associated with intermittent hyperglycemia of > or =24 h (OR 6.1, CI 1.8-21.2; p = 0.004). Hyperglycemia trended towards significance with mortality [3.2 (CI 0.9-11.6, p = 0.079)]. Hypoglycemia, after adjusting for the above, was not associated with mortality.

CONCLUSIONS

Organ dysfunction (> or =3 versus <3) was significantly associated with hyperglycemia for > or =24 h and hypoglycemia. Hyperglycemia trended toward significance with mortality in critically ill children. There was no association between hypoglycemia and mortality.