Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'?

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Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_5F70D0230562
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'?
Périodique
Tropical Medicine and International Health
Auteur(s)
Willcox Merlin L., Forster Mathieu, Dicko Moussa I., Graz Bertrand, Mayon-White Richard, Barennes Hubert
ISSN
1365-3156[electronic], 1360-2276[linking]
Statut éditorial
Publié
Date de publication
2010
Peer-reviewed
Oui
Volume
15
Numéro
2
Pages
232-240
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Résumé
OBJECTIVES: Hypoglycaemia (glucose <2.2 mmol/l) is a defining feature of severe malaria, but the significance of other levels of blood glucose has not previously been studied in children with severe malaria. METHODS: A prospective study of 437 consecutive children with presumed severe malaria was conducted in Mali. We defined hypoglycaemia as <2.2 mmol/l, low glycaemia as 2.2-4.4 mmol/l and hyperglycaemia as >8.3 mmol/l. Associations between glycaemia and case fatality were analysed for 418 children using logistic regression models and a receiver operator curve (ROC). RESULTS: There was a significant difference between blood glucose levels in children who died (median 4.6 mmol/l) and survivors (median 7.6 mmol/l, P < 0.001). Case fatality declined from 61.5% of the hypoglycaemic children to 46.2% of those with low glycaemia, 13.4% of those with normal glycaemia and 7.6% of those with hyperglycaemia (P < 0.001). Logistic regression showed an adjusted odds ratio (AOR) of 0.75 (0.64-0.88) for case fatality per 1 mmol/l increase in baseline blood glucose. Compared to a normal blood glucose, hypoglycaemia and low glycaemia both significantly increased the odds of death (AOR 11.87, 2.10-67.00; and 5.21, 1.86-14.63, respectively), whereas hyperglycaemia reduced the odds of death (AOR 0.34, 0.13-0.91). The ROC [area under the curve at 0.753 (95% CI 0.684-0.820)] indicated that glycaemia had a moderate predictive value for death and identified an optimal threshold at glycaemia <6.1 mmol/l, (sensitivity 64.5% and specificity 75.1%). CONCLUSIONS: If there is a threshold of blood glucose which defines a worse prognosis, it is at a higher level than the current definition of 2.2 mmol/l.
Mots-clé
Biological Markers/blood, Blood Glucose/analysis, Child, Child, Preschool, Epidemiologic Methods, Female, Humans, Hypoglycemia/blood, Hypoglycemia/diagnosis, Infant, Infant, Newborn, Malaria/blood, Malaria/complications, Male, Prognosis
Pubmed
Web of science
Open Access
Oui
Création de la notice
24/11/2010 9:21
Dernière modification de la notice
20/08/2019 14:17
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